Author: Zheng Jun

Affiliation: Peking Union Medical College Hospital

Introduction to Type I Arch Hybrid Procedures

Type I arch hybrid procedures address complex challenges associated with the aortic arch’s hemodynamics and anatomy, particularly the high amplitude pulsation in Zone 0, which increases the complexity and risk of these surgeries. The document emphasizes the evolution of techniques to improve perioperative outcomes and surgical success rates.

Inherent Challenges and Technical Difficulties

• Dynamic Blood Flow Impact: The main difficulty lies in managing the intense blood flow impact in Zone 0, increasing surgical complexity and risk.

• Y-Graft Application: Although effective in providing support for branch vessels, creating a sufficient length for stable anchoring and controlling bleeding remains a challenge.

Perioperative Mortality and Endoleak Issues

• Statistical Overview: A meta-analysis covering studies from 2000 to 2016 with 1021 patients shows a short-term mortality rate as high as 14% and an endoleak rate of 7.1% when dealing with Zone 0, highlighting the need for technical improvements.

Technical Improvement Strategies

• Optimized Graft Design: Introduction of dual “Y” shaped grafts to enhance branch vessel anastomosis and extend the anchoring zone to reduce risks of endoleaks and graft migration.

• Stabilization Techniques: Methods such as wrapping the ascending aorta and part of the aortic arch are discussed to provide a stable anchoring area.

Long-term Follow-up and Effects

• Clinical Outcomes: A study from 2019 to 2022 involving 44 cases showed promising early and mid-term results. The procedures had a high success rate with a perioperative mortality rate of only 2.3%, without serious complications like transient paralysis, retro-tearing, endoleak, or migration.

Conclusion and Future Outlook

Zheng Jun concludes by summarizing the current advancements in Type I arch hybrid technology, envisioning future developments, and emphasizing the importance of continuous innovation to enhance surgical safety and effectiveness.

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