Hybrid method in treatment of thoracic aortic disease

Despite rapid development of surgical technique, methods of cerebral and visceral organs’ protection and patient condition monitoring, surgical treatment of thoracic aortic pathology is still associated with high perioperative mortality. In the article we report the results of hybrid treatment of 64 patients with aneurysms and dissections of thoracic aorta and severe comorbidity (January 2009 – September 2014). Retrospective analysis has been performed in order to evaluate the efficacy of hybrid method of treatment in patients with high surgical risk. During the previously mentioned period there were performed the following interventions: left subclavian artery debranching with following stenting of thoracic aorta was performed in 24 (37,5%) cases, subtotal debranching and total debranching – in 12 (18,6%) and 18 (28,1%) cases respectively. Borst procedure followed by stenting of descending thoracic aorta was performed in 10 (15,6%) patients. The shortterm results were evaluated during the hospital stay of the patients, which varied from 8 to 30 days. The longterm results were estimated in 12 months after the intervention.

In 3,1% of cases endoleak type II was detected (because of false lumen filling from the intercostal arteries, 1 week later there was no endoleak observed). In 1 (1,56%) patient there was III type endoleak detected on the control aortography, probably caused by stent-graft defect, which was eliminatedafter ad- ditional stent-graft placement. Transient paraparesis developed in 1 patient with total elimination of the symtoms after spinal drainage implantation and spinal fluid evacuation. In one case transient isch- emic attack during aortic stenting was observed – the symptoms totally disappeared in 3 hours after the procedure. In-hospital mortality after hybrid treatment was 3,34%. 1-year survival in discharged patients was 100%. There was no bypass occlusion or stenosis detected during 1 year after the hybrid reconstruction (100% bypass patency).

Thus, hybrid method of treatment may be considered as an alternative to traditional surgical procedures and is the method of choice in patients with severe comorbidity. Hybrid method decreases the surgical trauma and facilitates the surgical technique.