[Aortic arch debranching in hybrid thoracic aortic replacement].

One patient (0.9%) died from thoracic aorta rupture after retrograde dissection. There was a moderate decrease of blood flow velocity through the left vertebral artery after subtotal debranching without severe hemodynamic disorders. Despite mild surgical trauma, subtotal and especially total debranching are characterized by higher risk of thrombosis of branches with potential fatal outcomes. In young patients requiring subtotal aortic arch debranching, open reconstruction or repair with fenestrated stents is preferred. We recommend a Bavaria type II hybrid procedure for patients with high surgical risk. In our opinion, more physiological hybrid interventions with anatomical arrangement of supra-aortic vessels such as Elephant Trunk and Frozen Elephant Trunk procedures are preferred.