Combined Open and Stent Graft Repair of an Arch and Descending Thoracic Aortic Aneurysm: The Hybrid Procedure

Surgeons at The Methodist Hospital and the Methodist DeBakey Heart Center have a long history of contributions to the treatment of thoracic aortic aneurysms. In the 1950s, Dr. Michael E. DeBakey pioneered the use of artificial grafts for aortic replacement and Drs. DeBakey and Denton Cooley introduced the use of cardiopulmonary bypass to repair aneurysms of the ascending aorta and aortic arch. Dr. Stanley Crawford then introduced surgical repair of the descending and thoracoabdominal aneurysm. Half a century later, the Methodist DeBakey Heart Center has now performed more descending and thoracoabdominal aortic aneurysm repairs than any other institution in the world.

Despite these advances, treatment of aneurysms involving both the ascending aorta/aortic arch segment and the descending thoracic aorta have continued to pose a formidable surgical challenge: aortic arch repair traditionally requires circulatory arrest and profound hypothermia via median sternotomy followed by a later descending thoracic aorta repair through a left thoracotomy.

Recently, a patient who had undergone previous ascending thoracic aortic aneurysm repair for dissection presented with a large arch and descending thoracic aortic aneurysm and a high risk of standard surgical repair. A unique, minimally-invasive hybrid approach of open and stent graft repair with aortic arch debranching was successfully employed, again advancing the field of thoracic aortic surgery at the Methodist DeBakey Heart Center.