Surgical treatment for thoracoabdominal aorta pathology

 Material and Methods. A total of 29 patients with thoracoabdominal aortic pathology were operated in the Sukhanov Federal Center of Cardiovascular Surgery from January, 2016 to December, 2020. Among these patients, 19 patients had thoracoabdominal aortic aneurysm, six patients had type III aortic dissection, and four patients had corrected type I aortic dissection. The average age of patients was 58 ± 12 years and ranged from 29 to 73 years. To minimize the time of ischemia in visceral organs, we developed and implemented in clinical practice a new method for thoracoabdominal aorta reconstruction. The operations began with a distal bypass of the iliac arteries followed by a consecutive debranching of the left renal artery, superior mesenteric artery, and celiac trunk in the presence of natural blood circulation without clamping the aorta. The left ventricular bypass (pulmonary vein – branch of the prosthesis) was connected and aorta was clamped and opened only at the stage of prosthetic repair of the right renal arteries and intercostal arteries. The last step was a proximal anastomosis at the level of aortic isthmus.

Results. The rate of total postoperative mortality was 13.7% (four patients). Acute kidney injury requiring renal replacement therapy was detected in 10.3% of cases. Spinal complications such as temporal paraplegia were observed in two patients (6.9%). Respiratory failure was detected in four patients (13.7%). Bleeding requiring reoperation occurred in one patient
(3.4%).

Conclusion. The proposed new method for a surgical reconstruction of the thoracoabdominal aorta allowed to decrease aortic cross-clamp time, cardio-pulmonary bypass duration, and ischemia of the visceral organs and spinal cord, which directly contributed to the improvement of surgical treatment results in this category of severely ill patients. 

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