RESUMEN
AIM: Aim of the study was to evaluate a single center experience on hybrid treatment for thoracic aortic diseases, including aortic arch and ascending aorta endografting needing a total debranching from descending thoracic aorta and an antegrade endograft deployment from left ventricle. METHODS: Between January 2004 and December 2010 48 patients underwent thoracic aorta endografting, with coverage of at least one supra-aortic artery, because of atherosclerotic, dissecting and post-traumatic aneurysms or complications of previous aortic surgery. Supra-aortic trunks revascularization was obtained from ascending aorta, common carotid arteries and, in three cases, from descending thoracic aorta since the unavailability of common inflow sites. In three cases the antegrade endograft introduction through left ventricle (transapical approach, 2 cases) or ascending aorta (one case) was the only possibility for a safe deployment. RESULTS: Three groups have been identified on the basis of the proximal landing zone. Group A (27 patients): zone 2; Group B (9 patients): zone 1; Group C (12 patients): zone 0. The 30 days mortality was respectively 7.4%, 0% and 16%. Post operative paraplegia occurred in the 7.4% of group A, respiratory insufficiency and infections were the main post-operative complications with an incidence reaching 30% in each group. CONCLUSION: Hybrid procedures on aortic arch represent a possible treatment for cases unfit for open surgery despite the complication rates and mortality are not negligible. In selected cases, the endografting can be extended up to beyond the landing zone 0 where an antegrade transventricular endograft deployment and a supra-aortic perfusion from descending thoracic aorta represent a feasible option.
Asunto(s)
Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Ventrículos Cardíacos/cirugía , Anciano , Anastomosis Quirúrgica/instrumentación , Angiografía , Aorta Torácica/fisiopatología , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/fisiopatología , Velocidad del Flujo Sanguíneo , Ecocardiografía , Diseño de Equipo , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The aim of the study was to determine variables that could be used to predict survival in patients with ruptured abdominal aortic aneurysm (RAAA) and to assess the accuracy of the Glasgow Aneurysm Score (GAS) and the Acute Physiology Chronic Health Evaluation II (APACHE-II). From January 1998 to July 2006, 103 patients underwent operations for RAAA. For each patient, 44 variables were retrospectively recorded in a database. Data were analyzed with univariate and multivariate methods. In the univariate analysis significant predictors of death were hypotension (p=0.001), preexisting peripheral vascular disease (p<0.001), renal insufficiency (p=0.037), chronic obstructive pulmonary disease (p=0.028), level of HCO(3)(-) (p<0.001), intraperitoneal rupture (p=0.001), blood transfused (p<0.001), cardiac complications (p<0.001), and APACHE-II score (p=0.001). Multivariate analysis confirmed statistical significance for coexisting peripheral vascular disease (p<0.001), diastolic blood pressure at admission <60 mm Hg (p=0.039), APACHE-II score >18.5 (p=0.025), HCO(3)(-) <21 mg/dL (p<0.001), and intraperitoneal rupture of the aneurysm (p=0.011) as predictors of death. Results of the study suggested that different factors can be helpful in identifying those patients whose operative risk is prohibitive. APACHE-II, contrary to GAS, is an accurate system to predict postoperative death after repair for RAAA.