The Value of Hybrid Repair in TAAA
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1 University Heart Center Hamburg GERMAN AORTIC CENTER UHC The Value of Hybrid Repair in TAAA ES Debus, M Biehl, A Larena, T Kölbel, N Tsilimparis Department of Vascular Medicine University Heart Center Hamburg-Eppendorf, Germany
2 UHC Extensive Aortic Disease different Techniques Crawford, total replacement Total endovascular Repair Hybrid Techniques Combinations Abdominal Debranching: > 2700 publ still under discussion G A
3 Marfan, dtaaa, FET 3
4 Hybrid Debranching With Endovascular Repair for Thoracoabdominal Aneurysms: A Comparison With Open Repair Himanshu J. Patel, MD, Gilbert R. Upchurch, MD, Jonathan L. Eliason, MD, Enrique Criado, MD, John Rectenwald, MD, David M. Williams, MD, G. Michael Deeb, MD The Annals of Thoracic Surgery, Volume 89, Issue 5, Pages (May 2010) Conclusions. Hybrid debranching procedures may reduce early morbidity and yield similar late survival, even in a group considered high risk for open surgery. These data support the increasing utilization of a hybrid debranching and endovascular approach for patients requiring thoracoabdominal aneurysmectomy. 4
5 Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm G. Chad Hughes, MD,a Michael E. Barfield, et al. JVS 56:3 (2012) n=47 Conclusions Hybrid TAAA repair through complete visceral debranching and endovascular aneurysm exclusion is a good option for elderly high-risk patients less suited to conventional repair in centers with the requisite surgical expertise with visceral revascularization. A staged approach to debranching and endovascular aneurysm exclusion during a single hospitalization appears to yield optimal results. 5
6 Five-year Patency Rates of Renal and Visceral Bypasses after Abdominal Debranching for Thoraco-abdominal Aortic Aneurysms R. Shahverdyan *, M. Gawenda, J. Brunkwall Department of Vascular Surgery, University Hospital of Cologne, Kerpener Str. 62, Cologne D-50937, Germany EJVES 54:6 (2013) n=46 survival patency Conclusion: Hybrid repair demonstrates excellent results regarding long-term bypass 6 graft patency of renovisceral arteries except for the right renal artery.
7 Performance of Abdominal Debranching? Author Patients (n) 30-d-Mortality (%) Paraplegia (%) Renal Insufficiency (%) Mortality (%) Black et al, Resch et al, Zhou et al, Jenkins et al., NA Bockler et al, Wolf et al, Lee at al, Chiesa et al, Kabbani et al, Wan Ham et al,
8 EJVES pts / 10 y?
9 Limitations Survey Retrospective Different indications Emergency 15-37% Survey 6-13 years Different techniques of debranching Tactics: simultaneous staged Surgeon, OP-time, others. Conclusion? Hamburg UKE Retrospective: n = 32 Different indications Emergency 47% Survey 4.5 years Different techniques of debranching Tactics: staged 2 surgeons, min,.
10 Retrospective, n=30 (2010-7/2014) Criterium Aneurysm size 66 mm TAAA 7 (23,3%) Acute TBD 7 (23,3%) main Crawford type Type IV TAAA; 11 (36,7%) E_CDs/anesthesia/site/content/figures/ 4051F08.gif
11 Comorbidities Comorbidity Nicotine 6 (20%) Diabetes mellitus 6 (20%) Hypertension 27 (90%) Renal insufficiency 9 (30%) Kongestive Heart Failure 4 (13,3%) CHD 12 (40%) COPD 7 (23,3%) Marfan s Disease 6 (20%) ASA 3 20 (66,6%) ASA 4 11 (33,4%) BMI Re-OP Aorta 23,77 (19 46) 20 (66,7%)
12 Patency N=9 stenoses / occlusion (30%) N=7 secondary intervention Artery Artery operated N occlusion (% ) In follow up occluded/ stenosed? (%) Right renal A 25 (83,3%) 5 (20%) 1 Left renal A 25 (83,3%) 6 (24%) 1 SMA 29 (96,7%) 4 (13,8%) 0 27 (90%) 2 (7,4%) 0 Celiac Trunc Sec. Patency: 29/31 (93,5 %)
13 Outcome (30 days) Outcome 30-d mortality 11 (36,7%) Respiratory tract 7 (23,3%) Apoplex/TIA 2 (6,7%) Paraplegia 4 (13,3%) Renal impairment Hemodialysis 13 (43,3%) 4 (13,3%) Pancreatitis 1 (3,3%) Ischaemic Colitis 4 (13,3%) Intestinal Ischaemia 6 (20%) Peritonitis 4 (13,3%) Vascular Complications 11 (36,7%)
14 Hybrid Procedures in Marfan 12/09 03/14 7 Patients: 2 Loeys-Dietz (1 female) 5 Marfan (4 female) Operative course uneventfull No serious periprocedural complications 2 y follow-up
15 TEVAR in Marfan-Patients Catheterization and Cardiovascular Interventions 00: (2012)
16 Gore Hybrid Graft in Abdominal Debranching 16/13 07/14 9 Patients, 27 Grafts 2 Graft Occlusions follow-up uneventful
17 Conclusion Summary Abdominal Debranching are evolving In pts not prone for TotalEndoRepair or TotalOpenReplacement high risk, uncomfortable anatomy separate entity Surveys, literature: poor Quality Own Experience: Demanding Serios morbidity in Serious Disease High % Urgent Treatment and New Technology Favourable Outcome in TBD and Marfan Should Remain in our Armamentarium
18 University Heart Center Hamburg GERMAN AORTIC CENTER UHC The Value of Hybrid Repair in TAAA ES Debus, M Biehl, A Larena, T Kölbel, N Tsilimparis Department of Vascular Medicine University Heart Center Hamburg-Eppendorf, Germany
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