Hybrid repair of aortic aneurysm in patients with previous coarctation

Objectives: Hybrid operations combining open and endovascular techniques have evolved for patients with complex aortic and coexisting cardiovascular disease. Our objectives were to describe the repair techniques and assess the outcomes in patients undergoing hybrid repair for aneurysm associated with previous aortic coarctation. Methods: From 2004 to 2012, 14 patients underwent hybrid repair by elephant trunk with endovascular completion (n=5), frozen elephant trunk (n=8), or antegrade stent grafting (n=1). The mean age at surgery was 45 +/- 13.5 years. Of the 14 patients, 8 underwent supra-aortic arterial revascularization (ascending to subclavian bypass in 5, carotid-subclavian bypass in 2, or ascending to carotid and subclavian bypass in 1). Ten patients had a bicuspid aortic valve, 5 underwent concomitant aortic valve replacement, and 1 underwent valve repair. Six had a hypoplastic arch. Other procedures included ascending aortic repair (n=4), coronary artery bypass grafting (n=1), ascending to descending bypass (n=1), and subclavian aneurysm repair (n=1). One operation was an emergency, the others were elective. The mean maximum aneurysm diameter was 5.9 +/- 1.5 cm. Data were obtained from a prospective database and chart review. Results: No perioperative mortality, stroke, renal failure, or paraplegia occurred. One patient required prolonged intubation, another required reoperation for postoperative bleeding. Two endoleaks required repeat intervention. The mean length of stay was 9 +/- 5.5 days. One late death occurred from hypertensive crisis and associated disseminated intravascular coagulation. At a mean follow-up of 26 months, no aortic growth was found. Conclusions: Hybrid repair of postcoarctation repair aneurysm is a safe and effective, less-invasive treatment option for patients with complex anatomy and/or concomitant cardiac disease.