Significance of the level of implantation of the "E-vita open plus" hybrid stent graft into the descending aorta in the development of spinal ischaemic complications

Kozlov B.N., Panfilov D.S., Saushkin V.V., Kuznetsov M.S., Nasrashvili G.G., Andriyanova A.V., Shipulin V.M.

Cardiovascular Surgery Department, Scientific Research Institute of Cardiology, Tomsk, Russia

Spinal ischaemia in patients after reconstruction of the thoracic aorta is referred to the category of the most severe postoperative complications, especially in hybrid interventions. The present study was aimed at assessing the risks for the development of spinal ischaemia in patients after implantation of the "E-vita open plus" stent graft into the descending portion of the thoracic aorta during hybrid reconstruction.

The "E-vita open plus" hybrid stent graft (Jotec, Germany) was implanted to 18 patients presenting with various pathology of the thoracic aorta (dissection, aneurysms). All operations were carried out in the conditions of moderate hypothermia, circulatory arrest and antegrade perfusion of the brain through the brachiocephalic trunk.

It was determined that the distal end of the stent graft was located at the level of Th7–Th12. In 12 (66.7%) cases the "lower" edge of the stent graft was located at the level of thoracic vertebrae Th8–Th9. Before the operation the number of open pairs of intercostal arteries amounted to 10 [9, 11]. After the operation, the number of the open pairs of the segmental arteries amounted to 3 [1; 4], they were all in the lower thoracic portion; the above-located intercostal arteries were shut by the stent graft. In 17 (94.5%) cases in the early postoperative period there were no signs of spinal ischaemia. Only one (5.5%) patient was clinically diagnosed to have developed transient spinal ischaemia noted to disappear spontaneously within the first 24 hours.

A conclusion was made that using the "E-vita open plus" stent graft in the course of hybrid reconstruction of the thoracic aorta was accompanied by the minimal risk for spinal ischaemic complications. The level of the location of the distal edge of the stent graft is not the determining factor in the risks of spinal complications in of such similar operations.

KEY WORDS: aortic aneurysm, aortic dissection, "frozen elephant trunk", spinal ischaemia, endoprosthetic repair, hybrid operations, "E-vita open plus" stent graft.

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