Prótesis híbridas en el tratamiento de la patología compleja de la aorta torácica. Experiencia de un centro en España

Abstract

Introduction and objectivesThe hybrid prostheses combine a conventional vascular prosthesis with a nitinol stented portion to facilitate the simultaneous approach of the ascending aorta, aortic arch, and proximal descending aorta. Experience in the treatment of this complex thoracic aorta pathology is presented. MethodsA total of 28 patients underwent surgery using the E-vita prosthesis (n=27) or Thoraflex prosthesis (n=1) from October 2013. The experience and the medium-term results are presented. ResultsThe patient variables included: mean age: 64.1 years (SD: 14.5). Men: n=21 (75%). 17 aneurysms (60.7%), 5 acute aortic dissections (17.9%), 5 chronic dissections, 1 aortitis. Mean EuroSCORE logistic 20.2 (SD: 11.5). Prior cardiac surgery: n=5 (17.9%). Mean cardiopulmonary bypass time, aortic cross clamp time, circulatory arrest time and selective antegrade cerebral perfusion: 184.7min (SD: 52.6), 109.4min (SD: 46.3), 50.6min (SD: 19.6), and 75.7min (SD: 32). Bilateral antegrade selective cerebral perfusion: n=19 (67.9%). Temperature: 22.6°C (SD: 3.5). Distal anastomosis zone: Z1 (n=3, 10.7%), Z2 (n=18, 64.3%), and Z3 (n=7, 25%). Supra-aortic vessels re-implantation: En bloc (n=8, 28.6%), En bloc+bypass (n=13, 46.3%), and trifurcated graft (n=7, 25%). Second-stage distal aortic intervention: n=12 (10 endovascular, 1 open surgery, 1 combined). In-hospital mortality: n=3 (10.7%). Permanent stroke: n=2 (7.1%). Re-exploration due to bleeding: n=2 (7.1%). Mean follow-up: 16.6 months (SD: 18). 1-year survival: 89.3%. Mortality during follow-up: n=3 (2 cardiovascular). ConclusionsHybrid prostheses simplify the treatment of complex pathology of the thoracic aorta, often being able to resolve it in a single stage, or facilitating an open or endovascular second stage.