Abstract:

Article describes experience of Novosibirsk scientific-research institute of blood circulation pathology named after E.N.Meshalkin in hybrid interventions in aortic dissection.

Aim: was to estimate efficacy of hybrid methods in surgical treatment of aortic dissection .

Materials and methods: since 2011 - 17 operations on proximal aortic dissections and 8 operations on distal aortic dissection with use of hybrid methodics were made.

Results: mortality in early post-operative period - 2 patients and was determined by progression of heart insufficiency In late post-operative period, basing on MSCT data, thrombosis of false lumen of aortic dissection on the mark of stent-graft or bare-metal stent (descending thoracic aorta) was revealec in 7 of 10 patients (70%) and in all patients with hybrid endoprothesis. During observation in post-operative period, none of patients were marked as needed of operation on thoracic-abdominal aorta.

Conclusion: used techniques allow to gain number of advantages in this severe group of patients as n early post-operative period, and also in late post-operative period. Endovascular treatment, performing simultaneously with open surgical interventions - are safe for patient and easy for surgeon. More extended reconstruction of aorta in single-stage operation can exclude aneurysmatic degeneration and prevent operations on distal aorta. 

References

1.     Anagnostopoulos C., Prabhakar M., Kittle C. Aortic dissections and dissecting aneurysm. Am. J. Cardiol., 1972; 30:263-273.

2.     Borst H.G., Heinemann M.K., Stone C.D. Surgical treatment of aortic dissection. New York: Churchill Living- stone;1996. p.357.

3.     Tan M.E., Morshuis W.J., Dossche K.M.et al., Longterm results after 27 years of surgical treatment of acute type aortic dissection. Ann. Thorac. Surg. 2005; 80: 523-529.

4.     Driever R., Botsios S., Schmitz E., et al. Long-term effectiveness of operative procedures for Stanford type A aortic dissections. Cardiovasc. Surg. 2003;11:265-72.

5.     Ergin M.A., Phillips R.A., Galla J.D., et al. Significance of distal false lumen after type A dissection repair. Ann. Thorac. Surg. 1994;57(4):820-4.

6.     Safi H.J., Miller C.C., Reardon M.J., et al. Operation for acute and chronic dissection: recent outcome with regard to neurologic defect and death. Ann. Thorac. Surg. 1998; 66: 402.

7.     Di Bartolomeo R., Di Marco L., Armaro A., et al. Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis. Eur. J. Cardiothorac.Surg. 2009;35:671-675.

8.     Hirotani T., Nakamichi T., Munakata M., et al. Routine extended graft replacement for an acute type A aortic dissection and the patency of the residual false channel. Ann.Thorac.Surg. 2003; 76: 1957-1961.

9.     Milewicz D.M., Guo D.C., Tran-Fadulu V., et al. Genetic basis of thoracic aortic aneurysms and dissections: focus on smooth muscle cell contractile dysfunction. Annu. Rev. Genomics Hum. Genet. 2008;9:283-302.

10.   Kay-Hyun Park, Cheong Lim, Jin Ho Choi, et al. Midterm change of descending aortic false lumen after repair of acute type I dissection Ann. Thoracic Surgery. 2009; 87(1): 103-108.

11.   Kato M., Ohnishi K., Kaneko M. et al., New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 1996; 94 (9): 188-193.

12.   Di Bartolomeo R., Di Marco L., Armaro A., et al. Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis. Eur. J. Cardiothorac.Surg. 2009;35:671-675.

13.   Chernjavskij A.M., Al'sov S.A., Ljashenko M.M. i dr. Hybrid prosthesis in reconstruction of the arch and the proximal thoracic aorta in aortic dissection De Bakey type I Grudnaja i serdechno-sosudistaja hirurgija. 2012; 5: 11-15 [In Russ].

14.   Chernjavskij A.M. , Al'sov S.A., Lomivorotov V.V. i dr. Hybrid approach in the treatment of chronic proximal aortic dissection. Kardiologija i serdechno-sosudistaja hirurgija. 2012; 6: 103-106 [In Russ].

15.   Leobon B., Roux D.,Saccani S. et al: Type A aortic dissection: New surgical strategy using intraoperative stenting. J. Thorac.Cardiovasc. Surg.2006;131:482-483.

16.   Fattouch K., Sampognaro R., Navarra E.et al. LongTerm results after repair of Type A acute aortic dissection according to false lumen patency. Ann. Thoracic Surgery. 2009; 88: 1244-1250.

17.   Geirsson A., Bavaria J.E., Swarr D. et al. Fate of the residual distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm. Ann. Thorac.Surg. 2007;84:1955-64.

18.   Chernjavsij A.M., Al'sov S.A., Ljashenko M.M. i dr. Status of the thoracoabdominal aorta after reconstruction of the ascending aorta at the dissection De Bakey type I. Patologija krovoobrashhenija i kardiohirurgija. 2013; 2: 29-35 [In Russ].

19.   Czerny M., Stohr S., Aymard T., Sodeck G., et al. Effect on false-lumen status of a combined vascular and endovascular approach for the treatment of acute type A aortic dissection. European Journal of Cardio-Thoracic Surgery. 2012; 41: 409-413.

20.   Upchurch G. R., Creado E. Aortic aneurysms. Pathogenesis and treatment. 2008; 156p.

21.   Chang Ch.-P, Liu J., Liou Y-.M. The role of false lumen size in prediction of in-hospital complication after acute type B aortic dissection JACC V. 2008; 52: 1170-1176.

22.   Trimarchi S., Tolenaar J., Jonker F. Importance of false lumen thrombosis in type B aortic dissection prognosis. J. of Thoracic and Cardiovascular Surgery. 2013; 145: 208-212.