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

Q4 Medicine
V. Kravchenko, Andrii I. Perepeliuk, I. Zhekov, B. Cherpak, Oleh I. Sarhosh
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引用次数: 0

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.
转换主动脉弓血管形成支架-移植物固定无血管区技术在复合治疗胸主动脉瘤中的应用效果
胸动脉瘤和主动脉瘤,包括斯坦福B型动脉瘤,既不是A型动脉瘤,也不是B型动脉瘤,是心脏手术的一个复杂问题。长期以来,这种病理的治疗是通过开放的方法进行的,这与医院死亡率高有关。混合和血管内治疗大大减少了并发症的数量,提高了住院死亡率,尽管这些方法有特定的困难,研究和消除这些困难是现阶段心脏外科的一个紧迫问题。的目标。分析在主动脉弓内形成支架近端固定无血管区即“着陆区”的混合方法治疗B型和非a型非B型主动脉夹层的近期和远期疗效。材料和方法。2016年1月1日至2019年12月31日,在乌克兰国立阿莫索夫心血管外科研究所,122例患者因B型和非a型非B型主动脉夹层接受了手术治疗,其中57例(46.7%)患者接受了混合干预,包括形成“着陆区”,即主动脉弓的无血管部分来固定支架。Z0植入支架5例(8.8%),Z1植入支架24例(42.1%),Z2植入支架28例(49.1%)。使用的支架移植物有Lifetech Ankura(41例)、Relay(12例)、Medtronic Valiant(4例)。病理原因主要为B型急性主动脉瘤11例(19%)、B型亚急性主动脉瘤4例(7%)、B型慢性主动脉瘤30例(53%)、穿透性主动脉溃疡1例(2%)、原发性主动脉腔壁血栓1例(2%)、缩窄后主动脉瘤8例(14%)、胸主动脉瘤3例(5%)。结果。并发症共11例(19%)。手术类型中并发症数量分布均匀,部分去分支5/28(18%),次全去分支5/27(19%),全去分支1/2(50%)。医院死亡率为3/122(5.3%)。结论。所描述的治疗弓和降主动脉动脉瘤的方法具有真正的发展前景,因为与传统的“开放”手术相比,微创、缩短手术时间和在诊所花费的时间以及显着降低住院死亡率。
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来源期刊
CiteScore
0.20
自引率
0.00%
发文量
42
审稿时长
6 weeks
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