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Hybrid techniques for complex aortic arch surgery.

Open aortic arch repair can be technically demanding. The evolution of endovascular technology, the rapid adoption of various catheter-based aortic repair techniques, and the development of hybrid techniques are all steps toward avoiding the perioperative morbidity and mortality rates associated with traditional open aortic arch surgery. As the population ages, patients considered to be at too high a risk for an open repair are now treated by alternative means, such as a purely endovascular approach with custom-made devices, and “hybrid” options, such as a combination of open supra-aortic vessel debranching and the endovascular exclusion of pathologic conditions affecting the aortic arch. In June 1991, the Ukrainian surgeon Nikolay Volodos and his colleagues performed the first hybrid aortic arch repair.1 They combined open surgery for debranching of the aortic arch with stent-grafting of anastomotic dissections that remained from the patient's previous operation for coarctation. Volodos subsequently reported that the patient was still alive in February 2013 and that the endoprosthesis was stable.2