[Hybrid repair of aortic arch aneurysm]. / Traitement hybride des anévrismes de l'arche aortique.

BACKGROUND: The management of aortic arch aneurysms is challenging. If conventional surgery cannot be performed in high risk patients, endovascular treatment is confronted to the problem of endoleaks at long term. However, the hybrid repair combining a first surgical step and a second endovascular step is a new technique recently introduced in the therapeutic alternatives of aortic arch aneurysm but its long-term results are not well known. METHODS: We report a series of four patients who received hybrid treatment for aortic arch aneurysms in our department between 2016 and 2018. RESULTS: These were 3 men and 1 woman with an average age of 63 years [55-80 years]. All were hypertensive and only one patient had diabetes. The aneurysm was symptomatic of chest pain in all cases and it was ruptured in only one case. Preoperatively, the hemodynamic state was stable in the four patients with a mean aneurysm diameter of 60 mm [48-79 mm] on CT angiography and the landing zone was zone 0 in all cases. Under general anesthesia, the 1st step was surgical with the performance of an aorto-bicarotid bypass associated with a re-implantation of the left subclavian artery and a disconnection of the supraortic trunks. The 2nd stage was endovascular by the femoral route; with release of an aortic stent graft covering the ostia of all supraortic trunks. The final angiographic check-up showed complete exclusion of the aneurysm in all cases. The immediate postoperative follow-up was straightforward except for the onset of septic shock and death in a patient with an aneurysm ruptured in the left pulmonary branch initially. The mean follow-up was 12 months with a CT scan control which confirms the complete exclusion of the aneurysm and the absence of endoleak.

Constrictive pericarditis: 21 years' experience and review of literature.

To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our twenty-one years' experience in terms of clinical and surgical outcomes and risk factors of death after pericardiectomy. An analytic bicentric and retrospective study carried out on 25 patients (20 male) with CP underwent pericardiectomy, collected over a 21-years period. The mean age was 40.46±16.74 years [7.5-72]. The commonest comorbid factor was tabagism (52%). The most common etiology was tuberculosis (n = 11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%). Pericardiectomy was performed in all our patients within 2.9±3.19 months after confirmation of diagnosis. It was subtotal in 96% of cases. The commonest postoperative complications are pleural effusion (20%). Dyspnea was regressed within 1.8 months in 80% of cases and clinical signs of right heart failure within a mean duration of 1.62 months in 53% of cases. Perioperative mortality was 12% (3 deaths), late mortality was 4% (1 patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over class II and right ventricular dysfunction are the prognostic factors of mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no impact on mortality. CP is a rare disease, with non-specific clinical signs. Pericardiectomy is effective with a significant improvement of the functional status of patients and favorable outcome at short and long term nevertheless hospital mortality is not negligible and depends on many factors.