Staged Total Aortic Replacement

Eduard Charchyan, Deyyara Chakal

B.V.Petrovsky Russian Research Center of Surgery , Moscow, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: we presents our experience of staged repair of extensive aortic aneurysms. Material and methods: Between May 2015 and November 2017, 21patients underwent staged replacement of the whole aorta. Eighteen patients underwent antegrade replacement of the aorta (from the aortic root to bifurcation) and three patient - retrograde (in reversed order). Patients with antegrade replacement on the first stage underwent reconstruction on proximal aorta, and on the second stage - distal aorta. In 15 cases free-floating graft (6-7 cm long) was placed from the aortic arch into the true lumen of descending thoracic aorta. Three patients underwent the Frozen Elephant Trunk procedure at the first stage. In 18 operations for second-stage repair, 17 patients had thoracoabdominal aortic replacement, and one high-risk patient had hybrid approaches that involve visceral debranching and aortic endografting. In three patients the thoracoabdominal aorta is repaired first, one of them underwent staged repair using the reversed elephant trunk procedure. 

Results: The average time of CPB during the first stage of surgical treatment was 124.7 ± 9.8 min, blood loss 1360 ± 280 ml, during the second stage – CPB -76.2 ± 31.8 min, blood loss 1560 ± 460 ml. The interval between the first and second interventions was 7.1 ± 2.3 months.

No case of hospital mortality was observed, one- and three-month survival after the second stage of treatment was 100%. On the CT-scans, no deformation or contrast leak was detected.

Conclusion: an individual approach in determining the tactics of treatment in patients with extensive aortic pathology is a key point of modern treatment. Staged replacement of the aorta is a effective method of surgical treatment with satisfactory early and mid-term results.