Five Years Results of Aortic Arch Debranching

Objectives To evaluate early and five years results of partial or total arch debranching. Methods In 2001-2012, 100 consecutive patients underwent elective hybrid arch repair with debranching and stentgraft (TEVAR). Outcomes were stratified for extension of arch involvement. Primary outcomes were perioperative (30-day) and five years mortality. Results Mean patients age was 70.1years and 88 were males. 16 arches were repaired for dissection. Twenty patients required total debranching for diseases extended to Zone-0. In 55, debranching and TEVAR procedures were staged. At 30-day, death, stroke and paraplegia occurred in 6, 4 and 3 patients respectively. In 80, requiring partial debranching, the same outcome rates were 2.5%, 3.8% and 2.5%, respectively. In patients with dissections, there was no death, paraplegia or stroke. Extension to ascending aorta requiring total arch debranching was the only multivariate independent predictor for mortality (odds ratio, 11.4; 95% Confidence Interval 1.91-68.4; P = .008), but not for stroke or paraplegia. One retrograde dissection with successful repair, occurred after total debranching. Kaplan-Meier estimates of survival at 1, 3 and 5-years were 85.8%, 81.4% and 69.7%. Two reinterventions for endoleak were required and no migration or late aneurysm related mortality was recorded. Conclusions The incidence of stroke is acceptable after both total and partial arch debranching. Total debranching is an important predictor for mortality. Retrograde dissection may be infrequent complication with careful arch approach. After the perioperative interval, debranching is a safe and durable procedure up to 5 years.