One-Stage Triple Hybrid Arch Debranching

Traditionally, repair of complex arch and descending aortic disease has required a two-stage surgical approach. We describe a novel one-stage repair that combines primary revascularization of the subclavian with stent coverage of diffuse aortic disease. A 31-year-old woman with Marfan syndrome presented with a growing arch aneurysm. At age 16 years, she had undergone the Ross procedure followed by a redo sternotomy and valve conduit. On follow-up, a distal arch aneurysm measuring 6 cm with an aneurysmal upper thoracic aorta and a localized distal thoracic aortic dissection was identified. In one stage, triple hybrid off-pump arch debranching with endovascular stent grafting was performed using two GORE Hybrid Vascular Grafts to perform the distal left carotid and subclavian anastomoses, which provided complete primary arch debranching without requiring a carotid-subclavian shunt. The patient had no complications, was discharged home on postoperative day 3, and continues to do well 3 months postoperatively. We conclude that one-stage repair of complex aortic arch disease with primary revascularization of the subclavian is feasible.