Immediate results of intrathoracic innominate artery reconstructions

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OBJECTIVE

To evaluate the immediate results of surgical treatment of atherosclerotic lesions of innominate artery.

MATERIAL AND METHODS

During the period between 1983 and 2022, 180 interventions were performed for atherosclerotic lesions of innominate artery including 79 intrathoracic reconstructions. Patients were divided into 2 groups due to some changes in preoperative management and surgical technique. In the first group (n=47, 1983—1999), coronary angiography was not performed. Surgical access was performed through median sternotomy. Endarterectomy with linear replacement was performed for lesion of innominate artery bifurcation. In the second group (n=32, 2000—2020), coronary angiography with stenting was performed if necessary. Surgical access was performed through partial sternotomy, and multiple replacement of supra-aortic vessels was carried out for lesion of innominate artery bifurcation.

RESULTS

In-hospital complications: thrombosis — 3 (3.8%), stroke (right hemisphere) — 3 (3.8%), bleeding with re-sternotomy — 4 (5.1%), mediastinitis — 6 (7.6%), myocardial infarction — 4 (5.1%) cases. Mortality rate was 3.8% (n=3). Thrombosis, mediastinitis, myocardial infarction and mortality were not observed in the second group. Incidence of stroke was 1.4 times lower than in the first group. Two cases of thrombosed prosthesis in the first group arose after endarterectomy from innominate artery bifurcation with linear replacement. Stroke (p=0.003) and mediastinitis (p=0.000) were more common in patients with postoperative thrombosis of vascular prosthesis.

CONCLUSION

Changing the principles of preoperative management, choice of traumatic approach and changing surgical technique for atherosclerotic lesions of innominate artery made it possible to exclude thrombotic, purulent and cardiac complications, reduce the incidence of neurological complications and mortality.

Keywords:

brachiocephalic trunk

innominate artery

reconstruction of aortic arch vessels

atherosclerosis

intrathoracic reconstructions

immediate results

Authors:

D.F. Beloyartsev

Vishnevsky National Medical Research Center of Surgery

Z.A. Adyrkhaev

Vishnevsky National Medical Research Center of Surgery;
Russian Medical Academy for Continuous Professional Education

D.V. Polyansky

Vishnevsky National Medical Research Center of Surgery

Received:

25.10.2022

Accepted:

15.11.2022

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