Surgical Interventions on the Aortic Arch in Acute Type A Dissection

Victor Sokolov, Andrey Redkoborody, Nickolay Rubtsov, Rustam Muslimov, Denis Kosolapov

N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Report objective: presentation of results of emergency extended interventions on the proximal aorta in acute type A dissection.

Materials and methods. 218 operations for acute proximal aortic dissection (type A) were performed since 2014 until August 2017.48 (22%) patients were operated within 48 hours from the disease onset. The decision on inclusion of the aortic arch into the extent of operation was made depending on the dissection type, initial condition of the patient, localization of fenestration, size of the aortic arch and the state of the false lumen. The scheme was selected after analyzing pre- operative data: total replacement, hemi-arch or type II or III hybrid intervention. Sixty-three patients (28.9%) required inclusion of the aortic arch into the extent of operation: hemi-arc– 36 patients, total replacement of the aortic arch– 27 patients (of which 5 in combination with Borst procedure and 6 with frozen elephant trunk technique), total debranching with subsequent implantation of the stent graft into the aortic arch– 5 patients.

Results. Total hospital lethality was 29.4 % (64/218). Lethality in the group of patients who had an intervention on the aortic arch was 33.3 % (21/63). Main reasons of lethal outcome were: cardiovascular and respiratory failure, neurological complications. The latter were observed in 13 patients (20.6%) in the form of brain edema. Spinal blood circulation disorders were observed in one case.

Conclusions. Extensive application of hybrid technologies allows improving the results due to decreased incidence of neurological complications directly associated with the duration of total stop of blood circulation and application of various types of isolated cerebral perfusion.