Efficacy of left subclavian artery laser in situ fenestration combined with hybrid arch debranching surgery for aortic arch reconstruction in patients with Stanford type A aortic dissection

TL;DR

A new surgical technique combining laser fenestration and hybrid debranching improves outcomes for aortic dissection patients.

Contribution

Combining laser fenestration with hybrid debranching for aortic arch reconstruction is shown to reduce complications and improve success rates.

Findings

The ISLF group had shorter operative time and higher LSA reconstruction success.

LSA complication rates were significantly lower in the ISLF group.

Five-year survival rates were similar between the two groups.

Abstract

To investigate the early and mid-term outcomes of in situ laser fenestration (ISLF) of the left subclavian artery (LSA) combined with hybrid aortic arch debranching for aortic arch reconstruction in Stanford type A aortic dissection.

This retrospective study analyzed 57 patients (60+ years) treated from 2018 to 2023. LSA reconstruction-related complications were defined as: anastomotic bleeding, LSA occlusion, stent migration, or fenestration-related endoleak. Patients were divided into ISLF + debranching (n = 29) and debranching-only (n = 28) groups. Outcomes were compared using t-tests and Kaplan–Meier analysis.

The ISLF group had shorter operative time (323.1 ± 10.3 vs. 329.4 ± 7.2 min, P = 0.009) and higher LSA reconstruction success (100% vs. 75%, P = 0.013). LSA complication rates were lower in the ISLF group (3.4% vs. 28.6%, P = 0.025). Five-year survival was similar (79.3% vs. 75.0%, P = 0.575).

ISLF with hybrid debranching improves LSA reconstruction success and reduces complications without affecting survival.

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