[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]. / Znachenie urovnia implantatsii gibridnogo stent-grafta 'E-vita open plus' v niskhodiashchuiu aortu v razvitii spinal'nykh ishemicheskikh oslozhnenii.

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.

[Single-centre experience with implantation of the 'E-vita open plus' hybrid stent graft]. / Odnotsentrovyi opyt implantatsii gibridnogo stent-grafta 'E-vita open plus'.

Hybrid technologies appear to have been gaining ground in surgery of the thoracic aorta. The present study was aimed at assessing the immediate clinical outcomes of surgical treatment of diseases of the thoracic aorta by means of the 'E-vita open plus' hybrid stent graft. The 'E-vita open plus' hybrid stent graft was implanted to 18 patients. All operations were carried out in the conditions of moderate hypothermia. The brain was protected by unilateral cerebral perfusion through the brachiocephalic trunk. The duration of artificial circulation averagely amounted to 265.1 [214; 281] min., with the mean aortic cross-clamping time equalling 150.8 [121; 177] min., and circulatory arrest lasting 55 [47.5; 62.5] min. In one (5.5%) case resternotomy was performed for haemorrhage. Five (27.8%) patients required haemodialysis to perform for postoperative renal insufficiency. A further five (27.8%) patients were found to have transient impairment of cerebral circulation. One (5.5%) patient was diagnosed as having haemorrhage into the area of the 'old ischaemic focus', one (5.5%) patient developed transient spinal ischaemia spontaneously disappearing within the first 24 hours. There were no cases of cardiac complications. A conclusion was drawn that hybrid operations according to the 'frozen elephant trunk' technique yield satisfactory immediate clinical results of treatment in patients with thoracic aortic aneurysms and dissection.