Open surgical treatment of aneurysms and dissection of the thoracic and thoracoabdominal aorta

Shlomin V.V.¹, Gordeev M.L.², Bondarenko P.B.², Yurtaev E.A.¹, Didenko Yu.P.¹, Puzdryak P.D.¹, Drozhzhin I.G.¹, Kasyanov I.V.¹, Gusinsky A.V.², Grebenkina N.Yu.¹, Zvereva E.D.²

1) Municipal Multimodality Hospital №2,
2) National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia

Presented herein is experience in treating a total of 56 patients with pathology of the arch, descending and thoracoabdominal aorta from 1997 to 2017. Of these, 6 (11%) patients were diagnosed with a Crawford type I-II thoracoabdominal aortic aneurysm (TAAA), 20 (35%) patients with Crawford type III-IV TAAA, 18 (32%) were diagnosed as having an aortic arch aneurysm (AAA) and descending thoracic aortic aneurysm (DTAA), 12 (22%) had DeBakey type I and IIIb aortic dissection. To protect the visceral organs and spinal cord from ischaemia in 28 (50%) cases we used a temporal bypass from a synthetic vascular graft with zero porosity and measuring from 15 to 20 cm in diameter.

Results. Mortality within 30 days amounted to 14.3% (n=8), that after 30 days amounted to 10.7% (n=6): in elective operations – 12% (n=5) and 5.4% (n=3), in emergency operations – 21% (n=3) and 21.4% (n=3), respectively. The total in-hospital mortality amounted to 25% (n=14), equalling 19% (n=8) and 43% (n=6) for elective and emergency operations, respectively. Mortality in using temporal bypass in elective operation amounted to 9.5% (n=2) during 30 days and that without using this method to 14.3% (n=3), after 30 days being 9.5% (n=2) and 4.7% (n=1), respectively. Mortality for emergency cases with a temporal shunt during 30 days was 28.6% (n=2), without – 14.3% (n=1), after 30 days – 28.6% (n=2), without – 14.3% (n=1). In type I-II TAAA mortality within 30 days was 16.6% (n=1), after 30 days – 50% (n=2); type III-IV TAAA – 10% (n=2) and 15% (n=1); DTAA – 22.2% (n=4) and 33.3% (n=2); aortic dissection – 8.3% (n=1) and 16.6% (n=1). Acute renal failure (ARF) occurred in 6 (10.7%) patients and was more often observed in the group without temporal shunting. Events of spinal cord ischaemia with the development of spinal stroke occurred in 6 (10.7%) cases. Five-year survival amounted to 61%.

Conclusions. Temporal bypass in surgery of the thoracic and thoracoabdominal aorta may be used for prevention of ischaemia of visceral organs, kidneys and spinal cord in operations accompanied by cross-clamping of the descending thoracic aorta.

KEY WORDS: thoracoabdominal aortic aneurysm, descending thoracic aortic aneurysm, temporal bypass graft in aortic surgery, thoracoabdominal aortic dissection, aortic arch pathology.

P. 185

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