Hybrid technology in the surgical treatment of proximal aortic dissection

Aim. To assess results of Meshalkin National Research Medical Center and Tomsk National Research Medical Center in surgical treatment of DeBakey type I aortic dissection using hybrid technologies (“frozen elephant trunk”) compared with classical standard interventions.

Material and methods. The study included patients operated on successively in the 2002­2010 timeframe with a diagnosis of acute and subacute DeBakey type I aortic dissection. A retrospective observational comparison of the surgical treatment results of patients (two groups) was performed: using standard surgical approaches (beveled anastomosis or aortic arch replacement using multi­branched prosthesis) and frozen elephant trunk (FET) intervention. The groups included 70 and 31 patients, respectively. Mortality and morbidity were evaluated in the postoperative period, the frequency of aorto­related events — during the observation period.

Results. Mortality and the frequency of complications between the groups in the early and late postoperative periods did not differ. Aorto­related events of the groups in the long­term period differed statistically significantly in favor of hybrid interventions (p=0,005).

Conclusion. The hybrid technology of thoracic aorta reconstruction using “frozen elephant trunk” type allows to make one­step reconstruction of the aorta during its multilevel lesion. Observation of patients in the long­term period allows us to announce of a longtime, stable result of surgical treatment in the absence
of additional perioperative risks.

1. Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972 Aug;30(3):263-73. PMID: 4557973

2. Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, on behalf of the Oxford Vascular Study PM. Population-based study of incidence and outcome of acute aortic dissection and pre-morbid risk-factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031-2037. doi:10.1161/CIRCULATIONAHA.112.000483.

3. Bonser RS, Ranasinghe AM, Loubani M. et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection J. Am. Coll. Cardiol. 2011. Vol. 58. No. 24. P. 2455-2474. doi: 10.1016/j.jacc.2011.06.067

4. Gordeev ML, Uspenskij VE, Bakanov AYu et al. Reconstructive interventions on the aortic arch in surgical treatment of aneurysms and dissections of the ascending aorta. Circulation Pathology and Cardiac Surgery. 2016;20(4):45-57. dx.doi.org/10.21688-1681-3472-2016-4-45-57 (In Russ.)

5. Tan ME, Morshuis WJ, Dossche KM et al. Long-term results after 27 years of surgical treatment of acute type a aortic dissection. Ann Thorac Surg. 2005 Aug;80(2):523-9. doi: 10.1016/j.athoracsur.2005.02.059

6. Pape LA, Awais M, Woznicki EM et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015 Jul 28;66(4):350-8. doi: 10.1016/j.jacc.2015.05.029.

7. Di Bartolomeo R, Pacini D, Savini C. et al. Complex thoracic aortic disease: single-stage procedure with the frozen elephant trunk technique. J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S81-5; discussion S86-91. doi: 10.1016/j.jtcvs.2010.07.039.

8. Shrestha M, Beckmann E, Krueger H. et al. The elephant trunk is freezing: The Hannover experience. J Thorac Cardiovasc Surg. 2015 May;149(5):1286-93. doi: 10.1016/j.jtcvs.2015.01.044.

9. Safi HJ, Miller CC, 3rd, Estrera AL et al. Optimization of aortic arch replacement: two-stage approach. Ann. Thorac Surg 2007;83:S815–8. discussion S24-31 doi: 10.1016/j.athoracsur.2006.11.014

10. Etz CD, Plestis KA, Kari FA et al. Staged repair of thoracic and thoracoabdominal aortic aneurysms using the elephant trunk technique: a consecutive series of 215 first stage and 120 complete repairs. Eur J Cardiothorac Surg 2008;34:605–15 doi: 10.1016/j.ejcts.2008.04.045

11. Jakob H, Tsagakis K, Pacini D et al. The international E-vita Open registry: data sets of 274 patients. J Cardiovasc Surg 2011;52:717–23 PMID: 21894139

12. Gariboldi V., Grisoli D., Kerbaul F. et al. Long-term outcomes after repaired acute type A aortic dissections / Interactive, CardioVascular and Thoracic Surgery 6, 2007 47–51 PMID: 17669766

13. Chernyavskij AM, Al'sov SA, Lyashenko MM et al. The state of the thoracoabdominal aorta after reconstruction of the ascending aorta and arch of the aorta in dissection type I De Bakey. Circulation Pathology and Cardiac Surgery. 2013. T. 6. № 2. P. 29-35. doi:10.21688/1681-3472-2013-2-29-34 (In Russ.)

14. Chernyavskij AM, Lyashenko MM, Sirota DA et al. The fate of the distal aorta after proximal reconstruction for proximal aortic dissection in patients with Marfan syndrome. Russian journal of cardiology. 2016;(11):7-11. doi.org/10.15829/1560-4071-2016-11-7-11 (In Russ.)

15. Kozlov BN, Panfilov DS, Saushkin VV et al. Hybrid treatment of aortic dissection associated with Kommerell’s diverticulum. Interactive Cardiovascular and Thoracic Surgery. 2016;22(6):854-855. doi:10.1093/icvts/ivw031.