Tactics for Treating Thoracic Aortic Aneurysms using Hybrid and Endovascular Techniques in Patients with Concomitant Coronary Heart Disease

Keywords: aortic aneurysm, acute dissecting aortic aneurysm, aorto-coronary bypass, ischemic heart disease, coro-nary arteries, thoracic endovascular aortic repair, endovascular surgery, endograft

Abstract

The presence of ischemic heart disease (IHD) in patients with aortic dissection increases the risk of intraoperative and postoperative complications during aortic repair. Researches on the effect of IHD on the treatment outcomes of patients with type B aortic dissection have not been carried out often. Only single publications based on relatively small statistical material are devoted to this problem in the literature. The cohort of patients with aortic dissection and IHD is extremely complex, and surgical correction of this comorbid condition is still a controversial topic.

The aim. To analyze the impact of IHD with prior correction of coronary artery lesions on the results of hybrid and endovascular treatment of patients with thoracic aortic aneurysms.

Materials and methods. From 2017 to 2023, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, 245 patients with thoracic aortic aneurysm were treated using hybrid and endovascular techniques. Of these, 14 (5.7%) patients with coronary malperfusion underwent previous cor-rection of IHD either alone or in combination with prosthetics of the aortic valve, ascending aorta and arch of the aorta, initial section of the descending aorta (elephant trunk) with a good outcome. The comparison group included 30 (12.2%) patients who underwent endovascular or hybrid correction of the descending thoracic aorta without coronary pathology.

Results. In the experimental group, 5 complications (42.9%) were detected (3 in the intraoperative period and 2 in the postoperative period). The frequency of complications of a similar nature in patients without concomitant IHD (com-parison group) was 13.3%. Endoleak type 1 was also dominant in this group. In most cases, it was eliminated by balloon dilatation of the stent graft. Only in 1 case, Endoleak type 1b was the reason for re-intervention with placement of an additional stent after 6 months.

Conclusions. Studies show that the presence of even corrected IHD complicates the course of endovascular and hy-brid surgical treatment of thoracic aortic aneurysms, as evidenced by significantly higher rates of postoperative compli-cations, longer length of stay in the intensive care unit, as well as time on mechanical ventilation.

Preliminary myocardial revascularization in patients with IHD should be one of the main conditions for the endovas-cular treatment of aortic aneurysms, taking into account the specifics of performing such operations and the possibility of fatal complications with hemodynamically significant narrowing of the coronary arteries.

References

  1. Senser EM, Misra S, Henkin S. Thoracic Aortic Aneurysm: A Clinical Review. Cardiol Clin. 2021;39(4):505-515. https://doi.org/10.1016/j.ccl.2021.06.003
  2. Hashiyama N, Goda M, Uchida K, Isomatsu Y, Suzuki S, Mo M, et al. Stanford type B aortic dissection is more frequently associated with coronary artery atherosclerosis than type A. J Cardiothorac Surg. 2018;13(1):80. https://doi.org/10.1186/s13019-018-0765-y
  3. Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015;66(4):350-358. https://doi.org/10.1016/j.jacc.2015.05.029
  4. Marques-Rios G, Oliveira-Pinto J, Mansilha A. Predictors of long-term mortality following elective endovascular repair of abdominal aortic aneurysms. Int Angiol. 2018;37(4):277-285. https://doi.org/10.23736/S0392-9590.18.03988-3
  5. Rocha RV, Lindsay TF, Nasir D, Lee DS, Austin PC, Chan J, et al. Risk factors associated with long-term mortality and complications after thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2022;75(4):1135-1141.e3. https://doi.org/10.1016/j.jvs.2021.09.021
  6. Hysa L, Khor S, Starnes BW, Chow WB, Sweet MP, Nguyen J, et al. Cause-specific mortality of type B aortic dissection and assessment of competing risks of mortality. J Vasc Surg. 2021;73(1):48-60.e1. https://doi.org/10.1016/j.jvs.2020.04.499
  7. Matsushita A, Tabata M, Hattori T, Mihara W, Sato Y. Surgical treatment in the chronic phase for uncomplicated Stanford type B aortic dissection. PLoS One. 2024;19(2):e0298644. https://doi.org/10.1371/journal.pone.0298644
  8. Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al.; IRAD Investigators. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation. 2018;137(17):1846-1860. https://doi.org/10.1161/CIRCULATIONAHA.117.031264
  9. Nation DA, Wang GJ. TEVAR: Endovascular Repair of the Thoracic Aorta. Semin Intervent Radiol. 2015;32(3):265-271. https://doi.org/10.1055/s-0035-1558824
  10. MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, et al. The Society of Thoracic Surgeons/ Practice Guidelines on the Management of Type B Aortic Dissection. Ann Thorac Surg. 2022;113(4):1073-1092. https://doi.org/10.1016/j.athoracsur.2021.11.002
  11. Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P; ADSORB Trialists; Alric P, Canaud L, Janotta M, Raithel D, Malina W, Resch T, et al. Endovascular Repair of Acute Uncomplicated Aortic Type B Dissection Promotes Aortic Remodelling: 1 Year Results of the ADSORB Trial. Eur J Vasc Endovasc Surg. 2014;48(3):285-291. https://doi.org/10.1016/j.ejvs.2014.05.012
  12. Nienaber CA, Kische S, Akin I, Rousseau H, Eggebrecht H, Fattori R, et al. Strategies for subacute/chronic type B aortic dissection: The Investigation Of Stent Grafts in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg. 2010;140(6 Suppl):S101-S108; discussion S142-S146. https://doi.org/10.1016/j.jtcvs.2010.07.026
  13. Rocha RV, Lindsay TF, Austin PC, Al-Omran M, Forbes TL, Lee DS, et al. Outcomes after endovascular versus open thoracoabdominal aortic aneurysm repair: A population-based study. J Thorac Cardiovasc Surg. 2021;161(2):516-527.e6. https://doi.org/10.1016/j.jtcvs.2019.09.148
  14. Kusadokoro S, Adachi K, Shinshi M, Hori D, Nakata H, Yamaguchi A. [Combined Thoraco-abdominal Aortic Aneurysm Repair and Coronary Artery Bypass Grafting through a Left Thoracotomy]. Kyobu Geka. 2018;71(8):588-592. Japanese.
  15. Rajbanshi BG, Charilaou P, Ziganshin BA, Rajakaruna C, Maryann T, Elefteriades JA. Management of Coronary Artery Disease in Patients With Descending Thoracic Aortic Aneurysms. J Card Surg. 2015;30(9):701-706. https://doi.org/10.1111/jocs.12596
Published
2024-06-27
How to Cite
Zhekov, I. I., Kravchenko, V. I., Sarhosh, O. I., Osadovska, I. A., & Rudenko, A. V. (2024). Tactics for Treating Thoracic Aortic Aneurysms using Hybrid and Endovascular Techniques in Patients with Concomitant Coronary Heart Disease. Ukrainian Journal of Cardiovascular Surgery, 32(2), 86-91. https://doi.org/10.30702/ujcvs/24.32(02)/ZhK031-8691

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