Thoracoabdominal Hybrid Repair: Initial Clinical Experience Using a New Device

Abstract

Objective: Hybrid repair for thoracoabdominal aortic aneurysm (TAAA) using the Thoracoflo device offers a less invasive staged repair approach compared with conventional open TAAA repair by avoiding thoracotomy, aortic cross-clamping, and extracorporeal circulation for selective visceral perfusion. End-to-side attachment of an iliac side branch of the device allows continuous pulsatile blood flow to the visceral and ileohypogastric vessels after deployment of the thoracic segment of the hybrid graft until the aneurysm sac is opened for collar and distal anastomosis. Method(s): Fifty-two patients classified as high risk for conventional open TAAA repair due to previous thoracotomy and comorbidities or unsuitable for conventional repair for anatomical reasons, such as access vessels, narrow true lumen, or kinked anatomy, were selected for Thoracoflo hybrid repair by interdisciplinary board decision. Surgery was performed in selected centers with high experience in open and endovascular TAAA surgery in Europe (n = 48), the United States (n = 1), Canada (n = 1), and Australia (n = 1). Special team training and supervision by proctoring were performed throughout the procedure. Result(s): TEVAR was performed to create a landing zone for the stent graft section of the hybrid device before or during Thoracoflo implantation. Fifty-one implantations were technically successful; in one case, conversion to conventional open TAAA repair with extracorporeal circulation had to be performed. Severe bleeding from intercostal arteries was prevented by coil embolization, occlusion of the false lumen before surgery, or ligation of the intercostal arteries during implantation. The 30-day mortality rate was 20%. A database for detailed evaluation of complications, including the rate of spinal cord ischemia, kidney failure, and reinterventions, is currently under evaluation. Pitfalls and bailouts are summarized accordingly. Conclusion(s): The first clinical experience using the Thoracoflo hybrid device in high-risk patients rejected for conventional open and standard endovascular repair showed technical success during surgery. Thirty-day mortality was still high at 20%, but might decrease if the indication for treatment could be extended to patients with fewer comorbidities. Thoracoflo offers a customized solution for selected patients in specialized centers as staged repair. Copyright © 2025