Single-stage, off-pump hybrid repair of extensive aneurysms of the aortic arch and the descending thoracic aorta.

S urgical treatment of aortic arch aneurysms has been challenging. These aneurysms are usually treated with open surgical repair that requires cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA). Furthermore, in cases of aneurysms involving both the aortic arch and the descending thoracic aorta (DTA) extensive surgical incisions or staged procedures are often necessary, increasing the perioperative risk. The purpose of this report is to describe the use of an innovative, hybrid technique that avoids the use of CPB and HCA in a single-stage surgical treatment for highrisk patients with extensive aortic arch and DTA aneurysms and a non-aneurysmal ascending aorta (Figure 1). This technique employs surgical debranching and revascularization of the aortic arch, and placement of endovascular stent-grafts within the ascending aorta, the aortic arch and the DTA.