THE FEATURES OF SURGICAL TREATMENT OF COMORBID PATIENTS WITH ASCENDING AORTA AND AORTIC ARCH ANEURYSM
DOI:
https://doi.org/10.11603/2414-4533.2025.1.15184Keywords:
thoracic aorta, aneurysm of the ascending aorta and aortic arch, comorbid patient, coronary artery bypass graftingAbstract
The aim of the work: to evaluate the surgical outcomes of aortic arch correction in patients with concomitant cardiac pathology.
Materials and Methods. Between 2019 and 2023, surgical treatment was performed on 40 patients with aneurysms of the ascending aorta and aortic arch (or the arch alone). Coronary artery disease (CAD) was diagnosed in 8 (20.0 %) patients. The study participants were divided into two groups based on the scope of interventions. Group A (n=20, 50.0 %) included patients who underwent isolated correction of aortic arch aneurysms or dissecting aneurysms without concomitant cardiac interventions. Group B (n=20, 50.0 %) comprised patients who underwent additional cardiac surgical procedures, including coronary artery bypass grafting (CABG) in 3 (15.0 %) patients with CAD. Surgical interventions in Group B were characterized by longer duration (597.2 minutes vs. 465.4 minutes in Group A), extended cardiopulmonary bypass time (304.5 minutes vs. 264.6 minutes), and longer aortic cross-clamping time (175.0 minutes vs. 138.3 minutes).
Results. A total of 52 postoperative complications were recorded among the study cohort. The incidence of ischemic spinal cord complications was significantly higher in Group B (5 cases) compared to Group A (1 case). Patients who underwent CABG required special attention, as this subgroup demonstrated a significantly higher risk of postoperative ischemia of the spinal cord. The shorter duration and single-stage nature of these procedures significantly reduce the risks of complications and mortality, which is particularly crucial for patients with comorbidities that complicate the clinical course of the disease. Analysis of the obtained data revealed significantly longer operative time, cardiopulmonary bypass duration, aortic cross-clamping time, and higher blood loss in patients with concomitant pathologies compared to those with isolated aortic arch pathology (p<0.05).
Conclusions. The frequency of postoperative ischemia of the spinal cord correlates with the duration of the operation and blood loss. Patients with concomitant pathologies, especially in the presence of coronary artery disease requiring surgical correction, have a higher risk of postoperative complications.
References
Mazzolai L, Teixido-Tura G, Lanzi S, et al. ESC Scientific Document Group , 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM). European Heart Journal. 2024; 179. DOI: 10.1093/eurheartj/ehae179. DOI: https://doi.org/10.1093/eurheartj/ehae179
Bashir M, Mohammed I, Al-Tawil M, Jubouri M, Agbobu T, Chen EP. Frozen elephant trunk: the gold standard. Cardiovasc Diagn Ther. 2023; 30:13(3):623-27. DOI: 10.21037/cdt-23-144. Epub. 2023 Apr. 24. PMID: 37405021; PMCID: PMC10315428. DOI: https://doi.org/10.21037/cdt-23-144
Vernice NA, Wingo ME, Walker PB, Demetres M, Stalter LN, Yang Q, de Biasi AR. The great vessel freeze-out: A meta-analysis of conventional versus frozen elephant trunks in aortic arch surgery. Card Surg. 2022; 37(8):2397-407. DOI: 10.1111/jocs.16596. Epub. 2022 May 8. PMID: 35526122; PMCID: PMC9322650. DOI: https://doi.org/10.1111/jocs.16596
Preventza O, Liao JL, Olive JK, Simpson K, Critsinelis AC, Price MD, Galati M, Cornwell LD, Orozco-Sevilla V, Omer S, Jimenez E, LeMaire SA, Coselli JS. Neurologic complications after the frozen elephant trunk procedure: A meta-analysis of more than 3000 patients. J Thorac Cardiovasc Surg. 2020; 160(1):20-33.e4. DOI: 10.1016/j.jtcvs.2019.10.031. Epub. 2019 Oct. 17. PMID: 31757456. DOI: https://doi.org/10.1016/j.jtcvs.2019.10.031
Nakhaei P, Bashir M, Jubouri M, Banar S, Ilkhani S, Borzeshi EZ, Rezaei Y, Mousavizadeh M, Tadayon N, Idhrees M, Hosseini S. Aortic remodeling, distal stent-graft induced new entry and endoleak following frozen elephant trunk: A systematic review and meta-analysis. J Card Surg. 2022; 37(11):3848-862. DOI: 10.1111/jocs.16918. Epub. 2022 Sep. 7. PMID: 36069163. DOI: https://doi.org/10.1111/jocs.16918
Malaisrie SC, Szeto WY, Halas M, et al. The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg 2021; 735-58. DOI: https://doi.org/10.1016/j.jtcvs.2021.04.053
Sabe AA, Percy ED, Kaneko T, Plichta RP, Hughes GC. When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A Review. Ann Thorac Surg. 2021; 111(6):1754-762. DOI: 10.1016/j.athoracsur.2020.08.002. Epub. 2020 Aug. 31. PMID: 32882193; PMCID: PMC7457910. DOI: https://doi.org/10.1016/j.athoracsur.2020.08.002
Kim H, Kim J, Choe YH, Kim SM. The Prognostic Impact of Coronary Artery Disease and Aortic Aneurysm: Insights From CT Protocol for Simultaneous Evaluation of Coronary Artery and Aorta. J Korean Med Sci. 2023; 20:38(45):e379. DOI: 10.3346/jkms.2023.38.e379. PMID: 37987106; PMCID: PMC10659927. DOI: https://doi.org/10.3346/jkms.2023.38.e379
Carroll AM, King RW, Ghincea CV, Aftab M, Reece TB. Spinal cord protection for thoracoabdominal aortic aneurysm repair: from bench to bedside. Ann Cardiothorac Surg. 2023; 28:12(5):438-49. DOI: 10.21037/acs-2023-scp-08. Epub. 2023 May 15. PMID: 37817853; PMCID: PMC10561340. DOI: https://doi.org/10.21037/acs-2023-scp-08
Murana G, Campanini F, Fiaschini C, Barberio G, Folesani G, Pacini D. Spinal cord injury after frozen elephant trunk procedures-prevention and management. Ann Cardiothorac Surg. 2023; 28:12(5):500-02. DOI: 10.21037/acs-2023-scp-16. Epub. 2023 Sep. 22. PMID: 37817842; PMCID: PMC10561344. DOI: https://doi.org/10.21037/acs-2023-scp-16
Ghincea CV, Ikeno Y, Aftab M, Reece TB. Spinal Cord Protection for Thoracic Aortic Surgery: Bench to Bedside. Semin Thorac Cardiovasc Surg. 2019; 31(4):713-20. DOI: 10.1053/j.semtcvs.2019.02.025. Epub. 2019 Feb. 27. PMID: 30825587. DOI: https://doi.org/10.1053/j.semtcvs.2019.02.025
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