Hybrid technology in treatment of severe combined pathology

Chernyavsky A.M.¹, Kavteladze Z.A.², Chernyavsky M.A.¹, Edemsky A.G.¹

1) Centre for Surgery of the Aorta, Coronary and Peripheral Arteries, Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia,
2) Centre of Endosurgery and Lithotripsy, Moscow, Russia

The present report describes a clinical case concerning a two-stage hybrid operative intervention in a patient presenting with an aortic arch aneurysm associated with coronary artery disease. The first stage consisted in performing mammary coronary artery bypass grafting of the anterior descending artery, coronary artery bypass grafting of the right coronary artery, endoventricular plasty of the left ventricle according to the Dor technique, switching over of the brachiocephalic arteries to the ascending portion of the aorta with the vascular multiple-branch prosthesis Intergard. The second stage consisted in endoprosthetics of the aortic arch with a stent graft. The patient concerned belongs to a high-risk group for the development of postoperative complications. Endovascular techniques in the pathology involved may be an alternative to the conventional surgical treatment, since there is no necessity to use extracorporeal haemocirculation or deep hypothermal circulatory arrest. It is necessary to analyse the remote results, to work out the indications for the interventions concerned, especially in elderly and aged patients presenting with a variety of accompanying pathology.

KEY WORDS: hybrid surgery, bypass grafting, debranching, aortic arch aneurysm, aortic stent graft, endovascular interventions, endografts, Intergard.

P. 162-166

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