RESUMEN
Aim To present the first experience of performing the Frozen Elephant Trunk (FET) surgery in patients with thoracic aorta disease using a new Russian hybrid stent graft "Soft Elephant Trunk".Material and methods Between 2014 and 2021, 170 patients with thoracic aortic disease underwent complete aortic arch replacement using the FET technique. In 70 of these cases (since June 2019), a hybrid graft "Soft Elephant Trunk" was used. A specific feature of this graft is the conical reduction of the radial force of nitinol crowns and the soft distal end without radial force. The study endpoints were early postoperative results, as well as the absence of reoperations on the aorta, absence of stent-graft-associated complications, including distal stent-graft-induced fenestration, and survival at a mid-term follow-up of up to 2.5 years.Results Interventions were performed in patients with A type aortic dissection (n=51; 72.9 %), type B aortic dissection (n=13; 18.6 %), and thoracoabdominal aortic aneurysm (TAAA) (n=6; 8.5 %). In 14 (20 %) of these cases, interventions were performed after a primary intervention on the proximal aorta. Acute aortic dissection was diagnosed in 17 (24.3 %) cases. Aortic root replacement was performed in 21 (30 %) cases, David procedure in 5 (7.2 %) cases, Bentall-DeBono procedure in 11 (15.7 %) cases, and supracoronary graft placement in 33 (47.1 %) cases. There were no cases of paraplegia or paraparesis. Respiratory insufficiency was observed in 8 (11.4%) cases. In one (1.4%) case, acute renal failure developed, which required renal replacement therapy. In-hospital mortality was 4.3 % (3 patients died). Mean follow-up duration was 9 [4.25; 16]âmonths. Three-year survival was 94 % (95 % confidence interval, CI: 88-99.9) and absence of reoperation was 96.6 % (95 % CI: 90.1-100). There were no cases of distal stent-graft-induced fenestration in this group.Conclusion The new hybrid graft, due to its specific structure, provides prevention of distal stent-graft-induced fenestration and, thereby, a stable long-term result. Using this stent-graft is effective in patients with thoracic aorta pathology undergoing the FET surgery. However, further studies are needed to determine potential advantages and disadvantages of this new hybrid graft, to obtain long-term results and accumulate experience.
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Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Humanos , Prótesis Vascular/efectos adversos , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/etiología , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Stents/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
Aim To determine the effect of minimally invasive interventions on the quality of life (QoL), pain syndrome, and cosmetic effect in patients with a pathology of chest aorta as compared with a group of traditional access.Material and methods From 2016 through 2020, 77 of 226 (34%) patients with an aneurysm in the proximal chest aorta and mini-sternotomy were prospectively selected starting from 2017. To evaluate differences between the effects of mini-sternotomy and the traditional access on QoL and pain syndrome a control group of patients with full sternotomy (n=77) was formed using pseudorandomization. Intergroup comparison of QoL, pain syndrome, and cosmetic parameters was performed at various time points.Results Mini-sternotomy provided a decrease in pain syndrome both during the early period (day 3), and during movements upon discharge. Also, mini-sternotomy decreased the duration of stay in the hospital compared to full sternotomy (8.1±2.1 vs. 8.9±2.5âdays, respectively; Ñ>0.0331). A more frequent use of analgesics by patients with full sternotomy was noted. Mini-sternotomy was associated with a faster recovery of most QoL parameters according to the SF-36 questionnaire at one year after surgery. The questionnaire included summarizing parameters of physical and mental health components (Physical Health Component, Physical Health (PH): 54.3±11.9 vs. 58.2±8.2, respectively; p=0.046; Mental Health Component, Mental Health (MH): 53.8±6.8 vs. 57.8±9.5, respectively; p=0.013). In addition, patients with minimal access showed higher values of the cosmetic effect by a 5-score scale (4.08±0.8 vs. 4.39±0.8, respectively; p=0.049) and a greater interest to having a minimal access surgery.Conclusion Mini-sternotomy beneficially influences the pain syndrome, cosmetic outcome, and QoL and provides a shorter duration of rehabilitation and a sooner return to work and everyday life compared to full sternotomy.
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Implantación de Prótesis de Válvulas Cardíacas , Calidad de Vida , Humanos , Aorta Torácica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Resultado del Tratamiento , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Dolor , Estudios RetrospectivosRESUMEN
OBJECTIVE: To present our experience in the treatment of severe patients with mega aorta syndrome. MATERIAL AND METHODS: There were 49 patients with mega aorta syndrome for the period from May 2015 to March 2021. All patients underwent total aortic replacement from sinotubular junction (with staged aortic root repair, if necessary) to abdominal aorta bifurcation. All surgeries were elective. All patients were divided into two groups: group I (n=33; 67.3%) - staged replacement, group II (n=16; 32.7%) - one-staged replacement of the aorta via thoracophrenolumbotomy. The primary endpoints were mortality, perioperative parameters and complications. We also analyzed long-term freedom from aortic redo surgery and survival rate. RESULTS: Both groups were comparable by pre-, intra- and postoperative parameters. The interval between surgeries for staged approach was 7.1±2.3 months. Rehabilitation time considering two stages was longer in group I (13±2 vs. 5.5±1.1 months, p=0.0001). Between-stage mortality rate was 12% (n=4). Intraoperative mortality was absent in both groups. In-hospital mortality was 3% and 12% (p=0.25), overall mortality with between-stage interval - 10.2% and 12% (p=1.000), respectively. The follow-up period was similar (18±22.7 (range 1-71) and 23.3±19.1 (range 1-51) months, respectively (p=0.63)). In group I, 1-year, 3-year and 5-year survival rate considering between-stage mortality was 89% (95% CI 78-100%), 77.1% (95% CI 60.1-98.8%), 77.1% (95% CI 60.1-98.8%), respectively. In group II, 1-year and 3-year survival rate was 86.5% (95% CI 70.5-100%), plog-rank=0.88. Overall freedom from redo surgery was 92.9% (95% CI 80.3-100%) vs. 90.9% (95% CI 75.4-100%), plog-rank=0.072. CONCLUSION: One-stage total aortic replacement via thoracophrenolumbotomy is safe surgical treatment for mega aorta syndrome, especially in young patients with low surgical risk. Favorable outcomes may be expected in specialized centers with extensive experience in aortic surgery. Compared to staged approach, total aortic replacement eliminates the risks of between-stage aortic rupture. Therefore, it is a worthy alternative to other methods.
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Implantación de Prótesis Vascular , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Quirúrgicos Electivos , Mortalidad Hospitalaria , Humanos , Complicaciones Posoperatorias/diagnóstico , Síndrome , Resultado del TratamientoRESUMEN
We report a comorbid patient after redo Frozen Elephant Trunk procedure followed by recurrent infection of thoracic aortic prosthesis, deep sternal wound infection and extensive soft tissue defect. Closure with skin-muscle thoracodorsal flap and graft-sparing technique with omentoplasty is an alternative to total graft replacement for thoracic aortic graft infection in comorbid patients with concomitant extensive defect of the chest wall or recurrent infection in early postoperative period.
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Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Infecciones Relacionadas con Prótesis , Infecciones de los Tejidos Blandos/cirugía , Infección de la Herida Quirúrgica , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Humanos , Epiplón/trasplante , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Reoperación , Esternón/cirugía , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugía , Pared Torácica/cirugía , Resultado del TratamientoRESUMEN
Aim Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM).Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6â%) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1-38 months (min-max) in the MS group and 42±21 (1-61 months (min-max) in the CS group.Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (Ñ=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005).Conclusion The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients' stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.
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Implantación de Prótesis de Válvulas Cardíacas , Procedimientos Quirúrgicos Mínimamente Invasivos , Válvula Aórtica/cirugía , Humanos , Tiempo de Internación , Puntaje de Propensión , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To report our own experience of hybrid treatment using FET technique in patients with type A aortic dissection and concomitant lesion of aortic arch and ascending aorta. MATERIAL AND METHODS: There were 90 (28,3%) FET procedures for the period from January 2010 to August 2019. Type B aortic dissection was diagnosed in 19 (45,2%) patients. Type B aortic dissection combined with aortic arch aneurysm occurred in 11 (58%) cases, ascending aorta aneurysm - 15 (79%) cases. Patients underwent total arch and ascending aorta replacement via median sternotomy (upper partial J-shaped sternotomy in 3 cases). Valve-sparing interventions were performed in 58% of cases (aortic root repair - 6 (32%) patients, David procedure - 5 (26%) cases). Intraoperative features, early postoperative morbidity and in-hospital mortality were retrospectively analyzed. In long-term period, distal aortic remodeling, survival rate and incidence of redo interventions were evaluated. RESULTS: Mean CPB time was 166±27 min, aortic cross-clamping time - 93±23 min, duration of circulatory arrest - 43±11 min. Neurological complications and paraplegia were absent. In-hospital mortality was absent. Reversible acute renal failure without need for hemodialysis developed in 2 cases (11%). Two patients underwent repeated intervention (TEVAR) due to dSINE and negative aortic remodeling. Annual survival rate was 100%. Freedom from redo aortic surgery was 89,5%. CONCLUSION: FET surgery is an adequate alternative treatment for type B aortic dissection combined with lesion of aortic arch and ascending aorta. This approach ensures a one-stage repair in patients with contraindications to TEVAR. Unlike thoracotomy, FET procedure is valuable for simultaneous correction of cardiac and proximal aortic lesion, stabilizing the distal segments of dissected aorta. This is obvious advantage of this technique.