Results of radical reconstruction of thoracic aortic aneurysms using hemi-arch technique

Козлов, Б. Н.; Панфилов, Д. С.; Gorokhov, A. S.; Кузнецов, М. С.; Nasrashvili, G. G.; Шипулин, В. М.

doi:10.17116/kardio20169142-46

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…Всем пациентам было выполнено одномоментное протезирование АК и протезирование восходящей аорты с реконструкцией дуги аорты по типу "полудуги" в условиях умеренной гипотермии (28-30  С), циркуляторного ареста и антеградной перфузии головного мозга через брахиоцефальный ствол [7].…”

Section: операционный протоколunclassified

Changes in aortic root dimensions after ascending aortic repair with concomitant aortic valve replacement

et al. 2022

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The issue of ascending aortic repair with concomitant aortic valve replacement in pa-tients with ascending aortic aneurysm (AscAA) and aortic valve stenosis is still debatable.Aim. To analyze the dimension changes of the preserved aortic root after simultaneous ascending aorta repair and aortic valve replacement.Material and methods. This retrospective study included 102 patients who, from December 2012 to May 2022, underwent simultaneous aortic valve replacement and ascending aorta repair with hemiarch replacement. Patients were divided into 2 following groups based on the aortic valve morphology: group 1 — patients with bicuspid aortic valve (BAV) and AscAA (n=75), group 2 — patients with tricuspid aortic valve (TAV) and AscAA (n=27). Depending on the presence of aortic root dilatation (maximum diameter (d) >40 mm), each of the groups was additionally stratified into 2 more subgroups as follows: patients without aortic root dilatation (d≤40 mm) and patients with its dilatation (d>40 mm). The dynamics of the aortic root diameter was assessed by computed tomography angiography.Results. The mean follow-up period for patients was 36,2±14,6 months. Survival rate in the BAV+AscAA and TAV+AscAA groups was 96% and 100%, respectively (p=0,380). Freedom from aortic root resurgery was 100% in both study groups. In patients with dilated and non-dilated aortic root of the BAV+AscAA group, an increase in aortic root dimension was noted at a rate of 0,65±0,51 mm/year and 0,32±0,27 mm/year, respectively. In patients of the TAV+AscAA group, a regression in dilated and non-dilated aortic root diameter was observed as follows: 0,93±0,48 mm/year and 0,56±0,43 mm/year, respectively.Conclusion. In patients with AscAA in combination with BAV stenosis after a singlestep surgical intervention, a weak negative dynamics of non-dilated and dilated aortic root is observed in the mid-term follow-up period. In patients with AscAA and TAV, there is involutive alterations of the aortic root dimension during 3-year follow-up.

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Section: операционный протоколunclassified

Changes in aortic root dimensions after ascending aortic repair with concomitant aortic valve replacement

et al. 2022

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“…Технические подробности оперативной техники опубликованы ранее [10,11]. Вкратце, после выполнения стернотомного доступа подключали искусственное кровообращение по схеме брахиоцефальный ствол-правое предсердие и начинали постепенное охлаждение пациента до целевой температуры.…”

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Early postoperative effects of the hypothermia level during hypothermic circulatory arrest in patients with ascending aortic aneurysm

et al. 2020

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Aim. To compare the effectiveness and safety of ascending aortic hemiarch replacement performed during hypothermic circulatory arrest with different temperature regimens.Material and methods. The study included 104 patients with ascending aortic aneurysm, who underwent ascending aortic hemiarch replacement under hypothermic circulatory arrest and antegrade cerebral perfusion. Depending on the temperature regimen, all patients were divided into two comparable groups: group 1 (n=28) — patients operated on under mild hypothermia (29-31oС), group 2 (n=76) — patients operated on under moderate hypothermia (25-28oC).Results. Comparative analysis of intraoperative data between groups of patients with mild and moderate hypothermia revealed a significant difference in the duration of cardiopulmonary bypass (111 [97; 135] min vs 125 [108.5; 170] min, p=0,031) and surgery (240 [210; 270 ] min vs 275 [240; 330] min, p=0,003). In the early postoperative period, the best results were also obtained in patients of mild hypothermia group. In these patients, compared with moderate hypothermia group, there was a lower frequency of reoperation due to bleeding (3,5% vs 5,2%, p=0,572), a decrease in transfused fresh frozen plasma volume (2 [2; 4] vs 4 [2; 4], p=0,03), a decrease in the ventilatory support duration (10 [7; 16] hours vs 18 [10; 24] hours, p=0,002), as well as a bed-day decrease in intensive care unit (2 [2; 3] and 3 [2; 4] days, p=0,005). No neurologic deficit was found in any of the patients. In-hospital mortality had no significant intergroup differences (p=0,541).Conclusion. An increase in the temperature regimen during the ascending aortic hemiarch replacement performed under hypothermic circulatory arrest is relatively safe in relation to early postoperative complications. Mild hypothermia does not increase early postoperative surgical risks compared to moderate hypothermia.

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“…Протезирование восходящей аорты с формированием "агрессивного косого анастомоза" ("подудуга") выполняли в условиях умеренной гипотермии и циркуляторного ареста с унилатеральной антеградной пер-фузией головного мозга через брахиоцефальный ствол. Детали оперативной техники и обеспечения операции изложены нами ранее [6,7].…”

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Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

et al. 2020

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Aim. To compare the shortand medium-term outcomes of hemiarch and nonhemiarch replacement for ascending aortic aneurysm (AAA).Material and methods. The study included 151 patients with non-syndromic AAA who underwent an elective replacement. Patients were divided into two groups: group 1 (non-hemiarch, n=40) — standard ascending aortic replacement; group 2 (hemiarch, n=111) — ascending aortic replacement with the hemiarch anastomosis in conditions of moderate hypothermia and circulatory arrest with unilateral antegrade cerebral perfusion. To eliminate systematic differences between the compared groups, the propensity score matching (PSM) method was used.Results. Before PSM, there were no significant intergroup differences in the incidence of neurological complications, myocardial infarction, prolonged ventilation, or acute kidney injury. Bleeding-related reoperation rates and hospital mortality significantly differed between groups. After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality. Median-term survival and freedom from aortic reoperations also did not show significant intergroup differences.Conclusion. Hemiarch replacement for AAA does not lead to an increase in the incidence of postoperative complications, as well as the risk of shortand mediumterm mortality compared with non-hemiarch.

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Results of radical reconstruction of thoracic aortic aneurysms using hemi-arch technique

Cited by 6 publications

References 7 publications

Changes in aortic root dimensions after ascending aortic repair with concomitant aortic valve replacement

Changes in aortic root dimensions after ascending aortic repair with concomitant aortic valve replacement

Early postoperative effects of the hypothermia level during hypothermic circulatory arrest in patients with ascending aortic aneurysm

Ascending aortic aneurysm: propensity score matching analysis of hemiarch and non-hemiarch replacement

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