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J Thorac Cardiovasc Surg 2008;135:1268-1269
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr John Elefteriades (New Haven, Conn). I congratulate the authors on an outstanding paper on hybrid therapy for aortic arch aneurysm. The number of patients is large, the follow-up is quite complete, and the duration of follow-up is long. The mortality and stroke rates are excellent. I do take issue with the underlying theme of the paper, that a direct surgical approach to the aortic arch is to be feared and avoided in favor of extra-anatomic and stent-graft therapy. Direct approaches to the aortic arch are safe, durable, and time tested. Many series, including our own recently presented experience, show stroke and mortality rates with the conventional approach that are very comparable with those in your presentation.

Also, our experience shows that the descending aorta is not commonly problematic, even in the long term, after successful type A repair, raising doubt about whether adjunctive stent therapy in the descending aorta is really necessary.

I have 3 questions. My first question has to do with early mortality. You list your hospital mortality as 3%, but by 6 months 19% of the patients are dead. How did another 16% of the patients die within 6 months of hospital discharge? What was going on clinically and . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2008 135: 1261-1269. [Abstract] [Full Text] [PDF]