A single-center experience in the use of hybrid techniques for thoracic aortic pathology

Abstract

The hybrid method of treating thoracic aortic pathology is devoid of the disadvantages of traditional open surgery and, at the same time, has a broader range of applications than the endovascular method. From 2014 to 2019, we researched 122 patients with thoracic aortic pathology treated with the hybrid method (open surgery with thoracic endovascular aortic repair (TEVAR) at the National M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Science of Ukraine. In the general group, 34 patients had a descending aortic aneurysm without dissection or rupture; 71 patients had an aortic dissection (10 – acute, 9 – subacute, 52 – chronic), penetrating aortic ulcer (PAU) – 7, thoracoabdominal aneurysm (Crawford I-II) – 4, isolated aortic arch aneurysm – 2, residual enlargement aorta after previous ascending aortic grafting causing type A acute aortic dissection (TAAD) – 3, primary aortic thrombosis – 1. Patients admitted as elective surgery candidates had switched aortic arch vessels (debranching) in the first stage and TEVAR in the second stage. For emergencies (aortic rupture with uncontrolled bleeding, malperfusion syndrome), TEVAR operation was performed first. Long-term results of treatment after three and six months are satisfactory. The hybrid technique of aortic arch treatment using modern minimally invasive technologies can eliminate the pathology in the most dangerous segment of the main artery of the body, providing a reasonable level of hospital mortality – 4.2%, and a small number of neurological complications.