CONGRESS ABSTRACT

Introduction Intervention for aortic arch pathologies continues to struggle with relatively higher mortality, reintervention, and neurologic complications. The Hybrid technique for the treatment of aortic arch aneurism disease was introduced to simplify the procedure and improve the outcome,in patients with a more significant comorbid burden. This study presents our experience in hybridizing acute and chronic pathologies of the aortic arch, with “landing Zone” of the Endograft in zones 0, 1 and 2.   Methods From August 2021 to September 2023, 11 consecutive patients underwent hybrid aortic arch procedures at our institution. In two cases, a custom-made fenestrated stent was used to ensurf the left subclavian arte perfusionry, with the landing zone in zone 1. A bypass between the left carotid artery and the left subclavian artery was performed as a preliminary step in six patients. In two patients, a bypass between the ascending aorta and the supra-aortic trunks was performed in two patients, with the landing zone in zone 0. In one patient, a bypass was performed from the right carotid artery to both the left carotid and subclavian arteries using a single prosthetic conduit, followed by the implantation of a custom-made graft with a branch for the brachiocephalic trunk and landing in the ascending aorta. Results The mean age was 60 ± 15 years. The presenting pathologies included seven cases of acute type B aortic dissection, two cases of aortic arch aneurysm, one case of a large pseudoaneurysm at the origin of the brachiocephalic trunk, and one case of residual dissection in the descending thoracic aorta following surgery for type A aortic dissection. Two patients had previously undergone cardiac surgery. All patients survived the procedure. No cases of perioperative stroke or paraplegia were observed. A single case of postoperative acute renal failure was reported. The mean intensive care unit stay was 24 ± 16 hours, while the mean postoperative hospital stay was 5 ± 3 days. The mean follow-up period was 18 ± 6 months, with no cases of endoleak reported Conclusions The surgical treatment aortic arch pathologies continues to struggle with relatively higher mortality, reintervention, and neurologic complications. The hybrid approach to aortic arch diseases can be safely adopted and  is associated with excellent operative outcomes, as well as sustained protection from adverse aortic events also in old patients with severe comorbiditys.