Surgical treatment of type I aortic dissection with lesion of supra-aortic arteries

Mironenko V.A.; Garmanov S.V.; M.-B.T.Mamilov; Gadzhimuradov S.R.

doi:https://doi.org/10.17116/kardio202316031313

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

M.-B.T.Mamilov

Bakulev National Medical Research Center of Cardiovascular Surgery

Gadzhimuradov S.R.

Bakulev National Medical Research Center of Cardiovascular Surgery

ORCID: 0000-0002-3719-6110

Surgical treatment of type I aortic dissection with lesion of supra-aortic arteries

Authors:

Mironenko V.A., Garmanov S.V., M.-B.T.Mamilov, Gadzhimuradov S.R.

More about the authors

Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(3): 313‑320

DOI: 10.17116/kardio202316031313

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To cite this article:

Mironenko VA, Garmanov SV, M-BTMamilov, Gadzhimuradov SR. Surgical treatment of type I aortic dissection with lesion of supra-aortic arteries. Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(3):313‑320. (In Russ.)
https://doi.org/10.17116/kardio202316031313

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

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Abstract:

We present surgical treatment of type I aortic dissection complicated by cerebral malperfusion. The patient with stenosis of innominate artery, detachment and dissection of the left subclavian artery, kinking of carotid arteries, hemodynamically significant left vertebral artery, intracranial aneurysm of the right internal carotid artery underwent replacement of supra-aortic vessels, ascending aorta and aortic arch (elephant trunk procedure using vascular trifurcation prosthesis under adaptive perfusion). Branch-first technique was used. Cannulation of both axillary arteries, adaptive loop of heart-lung machine and additional arterial pump provided cerebral circulation through the temporary axillary-axillary shunt at the stage of replacement of supra-aortic vessels. We were able to correct circulatory parameters in accordance with the stage of surgery. The second stage implied descending thoracic aorta stenting.

Keywords:

aortic dissection

dissection of supra-aortic vessels

adaptive perfusion

adaptive loop of the great arteries

temporary arterial shunt

branch-first technique

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

M.-B.T.Mamilov

Bakulev National Medical Research Center of Cardiovascular Surgery

Gadzhimuradov S.R.

Bakulev National Medical Research Center of Cardiovascular Surgery

ORCID: 0000-0002-3719-6110

Received:

12.12.2021

Accepted:

20.01.2022

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References:

Conzelmann LO, Weigang E, Mehlhorn U, et al. GERAADA Investigators. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg. 2016;49(2):44-52. https://doi.org/10.1093/ejcts/ezv356
Saw LJ, Lim-Cooke MS, Woodward B, Othman A, Harky A. The surgical management of acute type A aortic dissection: Current options and future trends. J Card Surg. 2020;35(9):2286-2296. https://doi.org/10.1111/jocs.14733
Perera N, Matalanis G. Trends and controversies in type A aortic surgery in the 21st century: Branch first aortic arch replacement. J Card Surg. 2021;36(5):1766-1769. https://doi.org/10.1111/jocs.15037
Kazui T. Total arch replacement with separated graft technique and selective antegrade cerebral perfusion. Ann Cardiothorac Surg. 2013;2(3):353-357. https://doi.org/10.3978/j.issn.2225-319X.2013.05.05
Mironenko VA, Darvish NA, Garmanov SV, Gordeychuk NV. Replacement of the ascending aorta, aortic arch and brachiocephalic arteries using adaptive perfusion in a patient with brain malperfusion. Russian Journal of Thoracic and Cardiovascular Surgery. 2019;61(6):532-537. (In Russ.). https://doi.org/10.24022/0236-2791-2019-61-6-532-537
Bachet J. Open repair techniques in the aortic arch are still superior. Ann Cardiothorac Surg. 2018;7(3):328-344. https://doi.org/10.21037/acs.2018.05.05
Mironenko VA, Garmanov SV, Bakuleva NP, Grigoryeva YuV. Surgical treatment of a patient with type I aortic dissection complicated by cerebral perfusion insufficiency using a trifurcation vascular prosthesis. Russian Journal of Thoracic and Cardiovascular Surgery. 2020;62(1):57-61. (In Russ.). https://doi.org/10.24022/0236-2791-2019-61-6-532-537
Keeling WB, Leshnower BG, Hunting JC, Binongo J, Chen EP. Hypothermia and Selective Antegrade Cerebral Perfusion Is Safe for Arch Repair in Type A Dissection. Ann Thorac Surg. 2017; 104(3):767-772. https://doi.org/10.1016/j.athoracsur.2017.02.066
Urbanski PP, Lenos A, Kolowca M, Bougioukakis P, Keller G, Zacher M, Diegeler A. Near-infrared spectroscopy for neuromonitoring of unilateral cerebral perfusion. Eur J Cardiothorac Surg. 2013;43(6):1140-1144. https://doi.org/10.1093/ejcts/ezs557
Rudarakanchana N, Jenkins MP. Hybrid and total endovascular repair of the aortic arch. Br J Surg. 2018;105(4):315-327. https://doi.org/10.1002/bjs.10713
Iafrancesco M, Ranasinghe AM, Dronavalli V, Adam DJ, Claridge MW, Riley P, McCafferty I, Mascaro JG. Open aortic arch replacement in high-risk patients: The gold standard. Eur J Cardiothorac Surg. 2016;49(2):646-651; discussion 651. https://doi.org/10.1093/ejcts/ezv149
Charchyan ER, Abugov SA, Khachatryan ZR, et al. Postoperative care in patients with DeBakey type I aortic dissection: criteria of aortic remodeling and risk factors of disease progression. Pirogov Russian Journal of Surgery. 2019;5:6-17. (In Russ.). https://doi.org/10.17116/hirurgia20190516
Inoue Y, Matsuda H, Omura A, Seike Y, Uehara K, Sasaki H, Kobayashi J. Comparative study of the frozen elephant trunk and classical elephant trunk techniques to supplement total arch replacement for acute type A aortic dissection. Eur J Cardiothorac Surg. 2019;56(3):579-586. https://doi.org/10.1093/ejcts/ezz104
Mutsuga M, Banno H, Narita Y, Komori K, Usui A. Which is superior, the frozen elephant trunk technique alone or the classical elephant trunk technique followed by second-stage thoracic endovascular aortic repair for extensive aortic arch repair? Nagoya J Med Sci. 2020;82(4):657-666. https://doi.org/10.18999/nagjms.82.4.657
Di Bartolomeo R, Murana G, Di Marco L, Pantaleo A, Alfonsi J, Leone A, Pacini D. Frozen versus conventional elephant trunk technique: application in clinical practice. Eur J Cardiothorac Surg. 2017;51(1):20-28. https://doi.org/10.1093/ejcts/ezw335
Mkalaluh S, Szczechowicz M, Mashhour A, Zhigalov K, Easo J, Eichstaedt HC, Ennker J, Thomas RP, Chavan A, Weymann A. Total aortic arch replacement using elephant trunk or frozen elephant trunk technique: A case-control matching study. J Thorac Dis. 2018;10(11):6192-6200. https://doi.org/10.21037/jtd.2018.10.42