Postoperative care in patients with DeBakey type I aortic dissection: criteria of aortic remodeling and risk factors of disease progression

[Hybrid aortic repair in patients with type III aortic dissection and concomitant proximal aortic lesion]

OBJECTIVE

To report our own experience of hybrid treatment using FET technique in patients with type A aortic dissection and concomitant lesion of aortic arch and ascending aorta.

MATERIAL AND METHODS

There were 90 (28,3%) FET procedures for the period from January 2010 to August 2019. Type B aortic dissection was diagnosed in 19 (45,2%) patients. Type B aortic dissection combined with aortic arch aneurysm occurred in 11 (58%) cases, ascending aorta aneurysm - 15 (79%) cases. Patients underwent total arch and ascending aorta replacement via median sternotomy (upper partial J-shaped sternotomy in 3 cases). Valve-sparing interventions were performed in 58% of cases (aortic root repair - 6 (32%) patients, David procedure - 5 (26%) cases). Intraoperative features, early postoperative morbidity and in-hospital mortality were retrospectively analyzed. In long-term period, distal aortic remodeling, survival rate and incidence of redo interventions were evaluated.

RESULTS

Mean CPB time was 166±27 min, aortic cross-clamping time - 93±23 min, duration of circulatory arrest - 43±11 min. Neurological complications and paraplegia were absent. In-hospital mortality was absent. Reversible acute renal failure without need for hemodialysis developed in 2 cases (11%). Two patients underwent repeated intervention (TEVAR) due to dSINE and negative aortic remodeling. Annual survival rate was 100%. Freedom from redo aortic surgery was 89,5%.

CONCLUSION

FET surgery is an adequate alternative treatment for type B aortic dissection combined with lesion of aortic arch and ascending aorta. This approach ensures a one-stage repair in patients with contraindications to TEVAR. Unlike thoracotomy, FET procedure is valuable for simultaneous correction of cardiac and proximal aortic lesion, stabilizing the distal segments of dissected aorta. This is obvious advantage of this technique.