SURGICAL POLICYIN THE TREATMENT OF СAD PATIENTS WITH THORACIC AND THORACOABDOMINAL AORTIC ANEURYSMS

Yu.V. Belov, A.B. Stepanenko, A.P. Gens, V.V. Bazylev
Russian Scientific Center of Surgery, RAMS,
Moscow, Russia

The paper reviews an experience gained with the treatment of 30 CAD patients with thoracic and thoracoabdominal aortic aneurysms. They were examined and treated at the Department of Surgery of Aorta and Its Branches, RSCS RAMS from January 1991 to November 2004. All the patients were provided reconstructions for thoracic and thoracoabdominal aortic aneurysms. In 27 of them myocardial revascularization was performed concurrently with aortic reconstruction.When choosing the surgical policy we adhered to the concept of performing one-stage operations via a single access. In most cases, proximal anastomoses were, during surgical treatment of this pathology, constructed "atypically": with the aortic arch, brachiocephalic trunk: and carotid artery, with the descending aorta, and mammarocoronary bypass grafting was performed. On repair of aneurysms of the distal portion of the arch and descending aorta we accomplished an enlarged left-sided lateral thoracotomy or thoracophrenoretroperitoneal access. It is to be noted that myocardial revascularization was performed twice, using the descending aorta for establishment of proximal anastomosis of coronary bypass. In two cases, revascularization was carried out by means of mammarocoronary anastomosis. In one case, dual autogenous vein graft and replacement ox the descending aorta was performed from a transverse transbipleural access along the fourth intercostal space under extracorporeal circulation.In patients provided one-stage operation on the aorta and coronary-arteries, the main complication was bleeding at operation and in the short-term postoperative period. In staged surgical treatment of CAD patients with thoracic and thoracoabdominal aortic aneurysms, the complications arose from uncorrected coronary pathology, namely iron ischemia and myocardial infarction.Analysis of the results evidences that one-stage surgical treatment of thoracic and thoracoabdominal aortic aneurysm and CAD is an effective method which permits the attainment of beneficial results in 93.6% of patients.

KEY WORDS: surgical treatment, thoracic and thoracoabdominal aneurysms, coronary artery disease.

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