The Results of the Use of the Technique of Switching the Vessels of the Aortic Arch in the Formation of the Avascular Zone of Stent-Graft Fixation in the Hybrid Treatment of Thoracic Aortic Aneurysms

Abstract

Thoracic and aortic aneurysms, including Stanford type B and neither A nor B aneurysms, are a complex problem for cardiac surgery. For a long time, the treatment of this pathology was carried out through the open method, which was associated with high hospital mortality. Hybrid and endovascular treatment have significantly reduced the number of complications and improved in-hospital mortality, although such methods are associated with specific difficulties, the study and elimination of which is an urgent issue at the present stage of cardiac surgery. The aim. To analyze the immediate and first long-term results of treatment of type B and non-A non-B aortic dissection through the hybrid method with the formation of avascular zone of proximal fixation of the stent-graft in the aortic arch, i.e. “landing zone”. Materials and methods. For the period from January 1, 2016 to December 31, 2019 at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine 122 patients underwent surgical treatment for type B and non-A nonB aortic dissection, of whom 57 (46.7%) patients underwent hybrid intervention involving the formation of a “landing zone”, i.e. an avascular section of the aortic arch to fix the stent-graft. Stent-graft was implanted in Z0 in 5 (8.8%) cases, in Z1 in 24 (42.1%) cases, and in Z2 in 28 (49.1%) cases. The stent-grafts used were Lifetech Ankura (41 cases), Relay (12 cases), and Medtronic Valiant (4 cases). The main causes of pathology were type B acute aortic aneurysm (11 [19%]), type B subacute aortic aneurysm (4 [7%]), type B chronic aortic aneurysm (30 [53%]), penetrating aortic ulcer (1 [2%]), primary parietal thrombosis of the aortic lumen (1 [2%]), postcoarctation aortic aneurysm (8 [14%]), thoracic aortic aneurysm (3 [5%]). Results. The total number of complications was 11 (19% of cases). Among the types of operations, the number of complications was evenly distributed, 5/28 (18%) were observed in partial debranching, 5/27 (19%) in subtotal debranching and 1/2 (50%) in total debranching. Hospital mortality was 3/122 (5.3%). Conclusions. The described methods of treatment of aneurysms of the arch and descending aorta have real prospects for development due to minimal invasiveness, reduction of the duration of surgery and time spent in the clinic, and significantly lower in-hospital mortality compared to traditional “open” surgery.

Keywords

• tevar
• thoracic endovascular aortic repair
• covering of the left subclavian artery
• “landing zone”
• type b aortic dissection
• endoleak
• steal syndrome