Immediate results of simultaneous combined surgery for dissection of supra-aortic vessels, ascending aorta and aortic arch

Mironenko V.A.

Bakulev National Medical Research Center of Cardiovascular Surgery

ORCID: 0000-0003-1533-6212

Garmanov S.V.

Bakulev National Medical Research Center of Cardiovascular Surgery

ORCID: 0000-0001-8568-9043

Darvish N.A.

Bakulev National Medical Research Center of Cardiovascular Surgery

Kuts E.V.

Bakulev National Medical Research Center of Cardiovascular Surgery

Chegrina L.V.

Bakulev National Medical Research Center of Cardiovascular Surgery

Shundrov A.S.

Bakulev National Medical Research Center of Cardiovascular Surgery

M.-B.T.Mamilov

Bakulev National Medical Research Center of Cardiovascular Surgery

Immediate results of simultaneous combined surgery for dissection of supra-aortic vessels, ascending aorta and aortic arch

Authors:

Mironenko V.A., Garmanov S.V., Darvish N.A., Kuts E.V., Chegrina L.V., Shundrov A.S., M.-B.T.Mamilov

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Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(4): 259‑265

DOI: 10.17116/kardio202114041259

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To cite this article:

Mironenko VA, Garmanov SV, Darvish NA, Kuts EV, Chegrina LV, Shundrov AS, M-BTMamilov. Immediate results of simultaneous combined surgery for dissection of supra-aortic vessels, ascending aorta and aortic arch. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(4):259‑265. (In Russ.)
https://doi.org/10.17116/kardio202114041259

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OBJECTIVE

To evaluate the short-term results of simultaneous combined interventions on supra-aortic arteries, ascending aorta and aortic arch.

MATERIAL AND METHODS

There were 330 patients who underwent surgery for acute or chronic type A aortic dissection between 2011 and 2020. Significant damage to brachiocephalic arteries was identified in 33 (10%) patients. Men prevailed (n=21). Mean age of patients was 49±12.7 years (range 18 — 66). Damage to brachiocephalic arteries and aorta was determined by acute (n=3), subacute (n=9) and chronic (n=21) dissection. Adaptive perfusion, adaptive loop of arterial circuit and two perfusion pumps were used to ensure cerebral and visceral protection. Brain protection strategy and cerebral perfusion quality were analyzed using oximetry and transcranial Doppler sonography. Early outcomes of simultaneous combined operations were retrospectively assessed.

RESULTS

Total aortic arch replacement was performed in 15 patients, subtotal replacement — in 16 patients. No arch replacement was required in 2 cases. Conventional arch replacement using branched prosthesis was carried out in 10 patients, branch-first technique — in 23 cases. Supracoronary ascending aortic replacement was performed in 24 patients, Bentall-DeBono procedure — in 7 cases. Correction of ≥2 supra-aortic vessels was performed in 16 (48.5%) patients. In-hospital mortality was 12.1% (n=4). The main causes of mortality were bleeding following coagulopathy (n=2), cerebral edema (n=1), embolic occlusion of coronary artery (n=1). Postoperative stroke occurred in 3 (9.1%) patients, transient neurological deficit — in 5 (15.2%) cases.

CONCLUSION

Combined repair of proximal aortic segments and supra-aortic vessels is possible in case of high risk of cerebral malperfusion in patients with aortic dissection.

Keywords:

aortic dissection

cerebral malperfusion

adaptive perfusion

combined operations

Authors:

Mironenko V.A.

Bakulev National Medical Research Center of Cardiovascular Surgery

ORCID: 0000-0003-1533-6212

Garmanov S.V.

Bakulev National Medical Research Center of Cardiovascular Surgery

ORCID: 0000-0001-8568-9043

Darvish N.A.

Bakulev National Medical Research Center of Cardiovascular Surgery

Kuts E.V.

Bakulev National Medical Research Center of Cardiovascular Surgery

Chegrina L.V.

Bakulev National Medical Research Center of Cardiovascular Surgery

Shundrov A.S.

Bakulev National Medical Research Center of Cardiovascular Surgery

M.-B.T.Mamilov

Bakulev National Medical Research Center of Cardiovascular Surgery

Received:

20.10.2020

Accepted:

23.11.2020

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