Hybrid treatment methods for diseases of thoracic aorta

  • О. А. jr. Mazur National M. M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Sciences of Ukraine (Kyiv)
  • I. O. Ditkivsky National M. M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Sciences of Ukraine (Kyiv)
  • B. V. Cherpak National M. M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Sciences of Ukraine (Kyiv)
  • V. I. Kravchenko National M. M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Sciences of Ukraine (Kyiv)
Keywords: aortic aneurysm, aortic dissection, hybrid treatment, TEVAR, debranching, carotid-subclavian bypass

Abstract

Hybrid treatment of aortic pathology doesn’t have the drawbacks of conventional surgical methods. At the same time it has much wider possibilities of application than the endovascular method, which has significant anatomical limitations.

In years 2014–2017 41 patients of Amosov National Institute of Cardiovascular Surgery with thoracic aortic pathology underwent hybrid treatment (open surgery on aortic arch branches and TEVAR). (n=19) patients had descending aortic aneurysm without dissection or rupture; (n=19) patients had aortic dissection (n=4 – acute, n=2 – subacute, n=13 – chronic), two patients had aortic aneurysm rupture and in one case the patient had PAU.

Patients scheduled for elective surgery or those not in critical conditions had debranching of aortic arch at the first stage and TEVAR at the second stage. If they had life-threatening conditions (such as aortic rupture, visceral malperfusion), they underwent TEVAR immediately and after their condition improved, open surgery stage was conducted.

Patient check-ups took place three and six months after hybrid treatment. Mortality rate was 2,4%, which is much lower than mortality rates for open surgical repair of descending aorta. Among the complications there were type I endoleak at a remote period; carotid-subclavian shunt thrombosis, left subclavian artery dissection and trauma of n. laryngeus recurrens (one case each). Three-month and six-month results of the treatment were good.

References

1. Самофиксирующийся синтетический протез для эндопротезирования сосудов / Володось Н. Л. [и др.] // Вестник хирургии. – 1986. – Т. 137, № 11. – С. 123–124.

2. Volodos N. L. The origin of TEVAR / Chiesa R., Melissano G., Setacci C. [et al.] // History of aortic surgery in the world. – Turin (Italy), 2015. – P. 2–10.

3. David A. Nation. TEVAR: Endovascular Repair of the Thoracic Aorta / Nation D. A., Wang G. J. // Semin Intervent Radiol. – 2015. – Vol. 32, № 3. – P. 265–271.

4. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Associationof Percutaneous Cardiovascular Interventions (EAPCI) / Grabenwцger M., Alfonso F., Bachet J. [et al.] // Eur Heart J. – 2012. – № 33. – P. 1558–1563.

5. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair / Antoniou G. A., El Sakka K., Hamady M. [et al.] // Eur J Vasc Endovasc Surg. – 2010. – Vol. 39, № 6. – P. 683–690.

6. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases / Erbel R., Aboyans V., Boileau C. [et al.] // Eur Heart J. – 2014. – Vol. 35, № 41. – P. 2873–2926.

7. Multicentre analysis of current strategies and outcomes in open aortic arch surgery: heterogeneity is still an issue / Urbanski P. P., Luehr M., Di Bartolomeo R. [et al.] // Eur J Cardiothorac Surg. – 2016. – № 50. – P. 249–255.

8. Open surgical repair for chronic type B aortic dissection: a systematic review / Tian D. H., De Silva R. P., Wang T. [et al.] // Ann Cardiothorac Surg. – 2014. – Vol. 3, № 4. – P. 340–350.

9. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease / Hagan P. G., Nienaber C. A., Isselbacher E. M. [et al.] // JAMA. – 2000. – № 283. – P. 897–903.

10. Hybrid repair versus conventional open repair for thoracic aortic arch aneurysms (Protocol) [Електронний ресурс] / Elhelali A., Hynes N., Devane D. [et al.] // Cochrane Database of Systematic Reviews. – 2018. – № 1. – Режим доступу до журн. : http://onlinelibrary.wiley.com/ doi: https://doi.org/10.1002/14651858.CD012923/full.
Published
2018-03-12
How to Cite
MazurО. А. jr., Ditkivsky, I. O., Cherpak, B. V., & Kravchenko, V. I. (2018). Hybrid treatment methods for diseases of thoracic aorta. Ukrainian Journal of Cardiovascular Surgery, (1 (30), 67-71. https://doi.org/10.30702/ujcvs/18.30/15(067-071)
Section
PATHOLOGY of AORTA

Most read articles by the same author(s)