Hybrid method in treatment of patient with DeBakey type III aortic dissection, ascending and descending thoracic aortic aneurysm, aortic regurgitation and ischemic heart disease
Abstract According to literature data hybrid treatment’s results are combarable to traditional open aortic surgery. Moreover hybrid method is associated with decreased perioperative mortality, especially in high surgical risk patients. It also may be used in order to achieve the most radical effect of treatment without need to perform staged surgical intervention. In the following article we present a case report of successful hybrid treatment of DeBakey type IIIb aortic dissection, ascending and descending thoracic aortic aneurysm, aortic regurgitation and ischemic heart disease. The patient underwent a hybrid intervention: aortic root plasty. Replacement of ascending aorta and its arch using a multi-branch prosthesis in a modified H. Borst method. Descending thoracic aortic stenting (using stent-graft «MedtronicValiant»). Autovenous coronary artery (left anterior descending) bypass grafting. Left atrial appendage occlusion. Multislice computer tomography detected total false lumen thrombosis. Patient was discharged on the 16th day of postoperative period. The presented clinical case report proves that hybrid method may achieve aortic stabilization without need of staged intervention, leading to the most radical result of treatment and decreased mortality risk in patients with thoracic aortic disease.
Keywords:hybrid procedures, thoracic aorta, «frozen elephant trunk»
Clin. Experiment. Surg. Petrovsky J. – 2015. – N 1. – Р. 70–75.
References
1. Bavaria J., Milewski R.K., Baker J. et al. Classic hybrid evolving approach to distal arch aneurysms: toward the zone zero solution. J Thorac Cardiovasc Surg. 2010; Vol. 140. P. S77–S80.
2. Lee C.W., Beaver T.M., Klodell C.T. Jr, et al. Arch debranching versus elephant trunk procedures for hybrid repair of thoracic aortic pathologies. Ann Thorac Surg. 2011. Vol. 91, N 2: 465–71.
3. Fattori R., Cao P., De Rango P. et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013; Vol. 61: 1661–78.
4. Winnerkvist A., Lockowandt U., Rasmussen E., Rade- gran K. A prospective study of medically treated acute type B aortic dissection. Eur J Vasc Endovasc Surg. 2006; Vol. 32, N 4: 349–355.
5. Hiratzka L.F., Bakris G.L., Beckman J.A. et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010; Vol. 55: P. e27–e129.
6. Kunishige H., Myojin K., Ishibashi Y. et al. Predic- tors of surgical indications for acute type B aortic dissection based on enlargement of aortic diameter during the chronic phase. Jpn J Thorac Cardiovasc Surg. 2006; Vol. 54, N 11: 477–482.
7. Belov Yu.V., Charchyan E.R. Surgical treatment of distal aortic dissections. Angiologiya i sosudistaya khirurgiya [Angiology and Vascular Surgery]. 2010; Vol. 4: 155–64. (in Russian)
8. Kouchoukos N.T., Masetti P., Mauney M.C. et al. One-stage repair of extensive chronic aortic dissection using the arch-first technique and bilateral anterior thoracotomy. Ann Thorac Surg. 2008; Vol. 86: 1502–9.
9. Kouchoukos N.T., Mauney M.C., Masetti P. et al. Single-stage repair of extensive thoracic aortic aneurysms: experience with the arch-first technique and bilateral anterior thoracotomy. J Thorac Cardiovasc Surg. 2004; Vol. 128: 669–76.
10. Ius F., Hagl C., Haverich A. et al. Elephant trunk procedure 27 years after Borst: what remains and what is new? Eur J Cardiothorac Surg. 2011; Vol. 40: 1–11.
11. Grabenwoger M., Alfonso F., Bachet J. et al. TEVAR for the treatment of aortic diseases: a position statement from the EACTS and the ESC, in collaboration with the EAPCI. Eur Heart J. 2012; Vol. 33: 1558–63