Aim      Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM).Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6 %) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1–38 months (min-max) in the MS group and 42±21 (1–61 months (min-max) in the CS group.Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (р=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005).Conclusion      The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients’ stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.

OBJECTIVES Our goal was to present our experience with a hybrid approach to the frozen elephant trunk (FET) technique for the treatment of patients with chronic type B aortic dissection. METHODS Between January 2013 and July 2019, 86 patients underwent the FET procedure at our centre. In 20 patients, the indication was chronic type B aortic dissection with a concomitant proximal aortic lesion. We evaluated the sites of proximal and distal entries, luminal communication and originating visceral branches in the computed tomography scan data. Primary end points were hospital deaths, complications and follow-up survival. Secondary end points included reintervention, thrombosis of the false lumen and aortic remodelling. RESULTS There were no deaths, neurological complications or paraplegia during hospitalization; however, a few patients (10%) had temporary acute renal failure or required secondary aortic reintervention during the follow-up period. We performed thoracic endovascular aortic repair with stable aortic remodelling during follow-up. The follow-up survival rate was 92.3%, and 87.5% of cases did not require aortic reintervention. CONCLUSIONS The FET technique is an effective method for treating chronic Stanford type B aortic dissection in patients at high risk of retrograde type A aortic dissection, concomitant disease of the proximal aorta and unsuitable anatomy for thoracic endovascular aortic repair, which allows for single-stage radical correction. Compared with thoracic endovascular aortic repair, the FET technique excludes the risk of type Ia endoleak, retrograde type A aortic dissection and possible stent graft migration. This technique provides comparable midterm follow-up outcomes and freedom from reintervention.

В настоящее время метод выбора хирургического лечения пациентов с осложненным расслоением аорты III типа по DeBakey с сочетанным поражением дуги или восходящего отдела аорты не определен. Представляем наш опыт гибридного подхода с использованием методики Frozen Elephant Trunk (FET) для лечения таких больных. Материал и методы. В период с января 2010 по август 2019 г. в РНЦХ им. акад. Б.В. Петровского выполнено 90 (28,3%) операций FET, из них в 19 случаях показанием к вмешательству являлось расслоение B-типа в сочетании с аневризмой дуги в 11 (58%), аневризмой восходящего отдела аорты в 15 (79%) случаях. Пациентам выполнили полную замену дуги и восходящего отдела аорты из срединной стернотомии (в 3 случаях из J-образной мини-стернотомии). При реконструкции проксимальной аорты в 58% случаев произведены клапаносохраняющие вмешательства: в 6 (32%)-пластика корня, в 5 (26%)-операция David. Ретроспективно оценены интраоперационные показатели, осложнения, госпитальная летальность. В отдаленном периоде оценены КТ-динамика состояния дистальных сегментов аорты, выживаемость, частота повторных вмешательств. Результаты. Среднее время искусственного кровообращения 166±27 мин, ишемии миокарда 93±23 мин, циркуляторного ареста 43±11 мин. Неврологических осложнений и случаев параплегии не отмечено. Летальных исходов в госпитальном периоде не было. В 2 (11%) случаях развилась обратимая острая почечная недостаточность, не потребовавшая гемодиализа. У 2 пациентов выполнено повторное вмешательство-стентирование грудной аорты (TEVAR) ввиду развития надрыва интимы по дистальному краю стента-графта (dSINE) и отрицательного ремоделирования аорты. Однолетняя выживаемость составила 100%. Повторные операции на аорте не производили у 89,5% больных. Заключение. Операция FET является достойным альтернативным методом лечения расслоения аорты III типа в сочетании с поражением проксимальной аорты. Данная тактика обеспечивает одноэтапную коррекцию патологии за счет стабилизации дистальных сегментов расслоенной аорты. В отличие от других методик FET позволяет скорректировать патологические изменения сердца и проксимальной аорты, что является несомненным преимуществом.

OBJECTIVES We present our first experience of using a new dissection-specific hybrid stent graft (SG) (the ‘Soft Elephant Trunk’) in the frozen elephant trunk technique, in patients with non-acute DeBakey type I aortic dissection. METHODS Between September 2016 and February 2021, patients with non-acute DeBakey type I aortic dissection underwent the frozen elephant trunk procedure at our centre using 3 SG types: group Z used stiff, distal Z-shaped nitinol SGs (E-Vita, Medtronic); group R used a stiff, ring-shaped nitinol SG (Thoraflex); and group S used a soft, distal dissection-specific SG. Predictors of distal SG-induced new entry were analysed. End points were hospital- and midterm-follow-up results. RESULTS The study comprised 109 patients with 46 (42.2%), 22 (20.2%) and 41 (37.6%) patients in groups Z, R and S, respectively. No significant differences were found in early outcomes. Freedom from distal SG-induced new entry was comparable in groups Z, R and S (68.9% vs 92.9% vs 100%, log-rank = 0.14). There was no significant difference in follow-up between the groups. Four-year survival rates were 80.44%, 71.59% and 95.06% in groups Z, R and S, respectively. On multivariable analysis, the presence of connective tissue disorders [hazard ratio (HR) = 5.62, P = 0.11] and SG diameter (HR = 1.37, P = 0.034) were strong predictors of distal SG-induced new entry. CONCLUSIONS Dissection-specific hybrid SG with a soft distal end is effective in patients with non-acute DeBakey type I aortic dissection. Compared to non-soft distal SGs, this can reduce the incidence of distal complications. Long-term outcomes are necessary to determine the potential advantages and disadvantages of the new prosthesis.

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