1. New York Aortic Surgery Symposium 2010 Mohamad Bashir, Aaron Ranasinghe, David Quin, Ben Holloway, Jorge Mascaro, Robert Bonser The limited potential for hybridised thoracic endovascular aortic reconstruction in patients undergoing conventional aortic arch replacement

2. Introduction Thoracic endovascular aortic stent repair (TEVAR) is a rapidly developing technology in the treatment of aneurysms of the thoracic aorta Use of TEVAR in patients with aneurysmal disease in the aortic arch has the ability to either –increase the number of potentially treatable patients or –Compete with traditional arch repair

3. Objectives Review of the pre-operative anatomy and operative data to assess the potential suitability of patients with aneurysmal aortic arch disease undergoing conventional surgical repair for hybrid TEVAR

4. Methods Consecutive patients undergoing conventional aortic arch surgery between January 2005 and October 2009 were identified from our prospectively maintained database Pre-operative CT scans were sourced where available from our computerised hospital radiology database Operation notes and follow-up data were obtained on all patients

5. Methods CT scans were analyzed to assess maximal distal ascending and proximal descending aortic short- axis diameter Potential TEVAR landing zones were classified as a length of 20mm with a SAD < 40mm

6. Results 73 patients underwent conventional arch surgery during this time period 62 (85%) underwent total arch 11 (15%) underwent hemi-arch 71 (97%) had conservation of a three vessel cranial circulation

7. Pre-operative CT scans Available in 42 (58%) Median distal ascending SAD 5.4(4.2-6.5) cm Median proximal descending SAD 3.8(3.0-4.8) cm Of these only 17% and 19% had satisfactory zone 0 and zone 3 landing zones

8. Operative details 34 had documented atheroma of the supra-aortic vessels 71 required replacement of the ascending aorta 56 patients required additional proximal procedures –Aortic valve – 22 –Root – 33 –Mitral valve – 5 –CABG – 16 7 required descending aortic replacement 39 had an elephant trunk procedure

9. Conclusions 1.Only a minority of patients were suitable for TEVAR without zone 0 creation 2.In this series the majority of patients undergoing aortic arch replacement required additional procedures 3.The role of hybrid TEVAR in management of aortic arch pathology remains to be defined