CUHK pioneers one-stage hybrid aortic arch surgery for multisegment thoracic aortic aneurysm

The cardiothoracic surgical team at the Chinese University of Hong Kong (CUHK) has become the first in Asia to perform aortic arch surgery for multisegment thoracic aortic aneurysm (TAA) using a one-stage hybrid total aortic arch replacement (TAR) and frozen elephant trunk (FET) device.

In the past 2 years, the cardiothoracic surgeons have treated 25 patients with the one-stage hybrid TAR FET device. “This surgical advancement is associated with 0 percent mortality and <5 percent risk of complications, including bleeding, stroke and spinal cord injury, with reduced number of operations and shorter stays in hospital,” reported Dr Takuya Fujikawa of the Department of Surgery, CUHK.

Conventional thoracic aortic surgery in Asia is a multistaged stent grafting procedure that involves implantation of stent graft in the descending thoracic aorta, followed by anastomosis with vascular graft for arch vessel reimplantation and ascending aortic replacement. However, this approach requires a long and bulky aortic stent graft system with an endovascularly designed deployment mechanism. Furthermore, sewing cuff for anastomosis is absent at the distal arch. [J Card Surg 2021;36:793-795]

With the hybrid TAR FET device, all the operations can be completed in a single-stage procedure. It can prevent stent shortening after the procedure, and allows adoption of varied diameters and lengths of stents and arch segments for complex aortic arch diseases. [J Card Surg 2021;36:793-795; J Card Surg 2021;36:3963-3967]

Mock procedure of one-stage hybrid aortic arch surgery for multisegment thoracic aortic diseases

During the COVID-19 pandemic, travel restriction was the major challenge in introducing this one-stage hybrid device for clinical use. “We adopted a virtual proctoring platform to conduct procedural planning and intraoperative coaching with a German proctor,” said Professor Randolph Wong of the Department of Surgery, CUHK.

“We have demonstrated that the virtual platform is a feasible approach for implementing a new surgical device [ie, the one-stage hybrid device],” added Fujikawa. “Detailed preoperative planning and training, well-executed intraoperative procedures and careful postoperative monitoring are keys to excellent clinical outcomes.”

TAA (ie, maximum aortic diameter ≥4.5 cm or >50 percent increase in diameter compared with the adjacent aorta) is a common aortic disease among patients with hypertension. [Nat Rev Cardiol 2021;18:331-348; Ann Thorac Surg 2021;111:1554-1559] In patients with TAA, ≥1 aortic segment (including aortic root, ascending aorta and/or descending aorta) may be involved. [Circulation 2005;111:816-828]

“Between June 2016 and July 2018, our study [n=1,529] showed TAA in 7.5 percent of hypertensive patients,” reported Dr Jacky Ho of the Department of Surgery, CUHK. [Ann Thorac Surg 2021;111:1554-1559] “Notably, in this decade, the annual incidence of aorta-related diseases has increased from 20 cases to 100 cases, particularly in patients aged ≤50 years with aortic dissection.”