Hybrid Aortic Arch Treatment

A hybrid arch surgical approach is an option for elderly or high-risk patients undergoing treatment for aortic arch pathologies. It avoids cardiac conduction abnormality (CCA), hypothermia, and prolonged cardiopulmonary bypass (CPB) times. Despite new techniques like the total endovascular arch emerging, this technique still has its role for patients whose anatomy is not suitable.

This technique is staged in order to achieve a successful outcome. The first stage is purely surgical. A debranching and rerouting of the head vessels along with or without ascending aortic replacement is performed through median sternotomy to create a favorable landing zone. This makes it possible to deploy a TEVAR on the second stage and complete the treatment.

This video presents the case of a seventy-eight-year-old man suffering from a subacute type A aortic dissection with intramural hematoma and arch involvement. In addition, the patient had a lusory artery. After discussion, it was decided that the strategy would consist of a bilateral carotid-subclavian bypass followed by an ascending aortic arch replacement with carotid debranching and a thoracic endovascular aortic repair (TEVAR).