Anaesthetic Management of Hybrid Aortic Arch Repair: Supra-Aortic Debranching with TEVAR — A Case Series

Hybrid aortic arch repair using supra-aortic debranching followed by thoracic endovascular aortic repair (TEVAR) has emerged as an alternative to conventional open arch surgery requiring cardiopulmonary bypass with hypothermic circulatory arrest. These hybrid procedures pose distinct anaesthetic challenges related to cerebral protection, haemodynamic instability, systemic anticoagulation, and contrast exposure. We report a case series of three patients with aortic arch pathology who underwent supra-aortic debranching followed by TEVAR in a hybrid operating theatre under general anaesthesia. A standardized perioperative anaesthetic strategy was employed, incorporating invasive arterial pressure monitoring, advanced cardiac output monitoring using FloTrac™ (invasive blood pressure, cardiac output, stroke volume, and stroke volume variation), continuous cerebral oxygenation monitoring with near-infrared spectroscopy (NIRS), urine output monitoring for renal protection, and activated clotting time–guided anticoagulation maintained between 200–250 seconds. All procedures were completed successfully without intraoperative neurological complications, major haemodynamic instability, or perioperative mortality. Postoperative management in the cardiothoracic intensive care unit was uneventful, with preserved neurological function and stable renal parameters in all patients. This case series highlights that meticulous perioperative planning, advanced haemodynamic and cerebral monitoring, vigilant anticoagulation management, and close multidisciplinary coordination enable safe anaesthetic conduct of supra-aortic debranching and TEVAR in a hybrid operating environment