Authors:
Kadyraliev, B.K. 1,  Karasov, I.A.2, Umarov, A. H.2, Airapetyan, A.A.2,
Kolesnikova, J.A.2, Burak, E.S.2, Zhigalov, K.Y.3, Weymann, A.3
1 – Federal Centre of Cardiovacular Surgery named after S.G. Sukhanov of the Ministry of Healthcare of the Russian Federation, Perm, Russian Federation; 2 - Perm State Medical University named after academician E.A. Wagner of the Ministry of Healthcare of the Russian Federation;
3 - West German Heart Centre Essen, Department of Thoracic and Cardiovascular Surgery
Corresponding Author:Karasov I.A., e-mail:imyarek.yozhin@mail.ru ; address: 26, Petropavlovskaya St., Perm, 614000, Russian FederationConflict of interest : none
Financial support : The authors hasn’t any financial interest in the submitted materials or methods.Compliance with the ethics principles : informed consent for treatment and publication is obtained from patient.
Background: Aortic root aneurysms are traditionally treated by open surgery methods, which significantly increase the risk of postoperative complications. Elderly patients with a history of previous cardiac surgery have a higher risk of postoperative events and demand more careful supervision during hospitalization.Materials & Methods: We report a case of a 72‐year‐old female patient with aortic root aneurysm and a previous history of cardiac surgery (CABG) with a high risk for EuroSCORE II (15,52%). The postoperative period was uneventful.Discussion and Conclusion: We use this case to discuss the effectiveness and short‐term results of this procedure in patients with high risk.
Keywords: aortic aneurysm, CABG, hemiarch reconstruction
Introduction:Case presentation:The 72 years old female was admitted to the S.G. Sukhanov Federal Center of Cardiovascular Surgery (Perm, Russia) for examination, where she was diagnosed with aortic root pseudoaneurysm in May 2021. The patient suffered from coronary heart disease since 2011 (angina pectoris III FC), in 2012 she underwent CABG (six bypasses using great saphenous vein). Aortic root pseudoaneurysm was detected by transthoracic echocardiography. The image showed a pseudoaneurysm of the ascending aorta, obturated with thrombotic masses on 50% of the aortic lumen. Pseudoaneurysm spreaded from the aortic root to the aortic arch. Aortic valve was intact. On multispiral computer tomography large pseudoaneurysm of root and ascending part of the aorta with partial thrombosis and dilation of descending aorta were found. The aortic root diameter was 25 mm, isthmus diameter – 29 mm, size of pseudoaneurysm – 74x75 mm (Figure 1). The mortality risk was high with a EuroSCORE II of 15.52% due to the patient’s age, female sex, the center’s estimated surgical volume, and the present comorbidities. Despite the high risk, the patient was recommended for open pseudoaneurysm resection with hemiarch reconstruction. Intraoperatively, during the revision of the pericardium cavity, there was pronounced adhesion. The distal part of ascending aorta and aortic arch were dilated with signs of aortic rupture and formation of a hematoma. The aortic valve was intact, without any signs of significant insufficiency. After revision of the aortic arch, rupture on small curvature was discovered. The affected part of the aorta was excised (Figure 2). A distal anastomosis with the aorta was performed with a vascular prosthesis according to the hemiarch technique (Vascutek №28) (Figure 3). Proximal anastomoses of venous grafts cut out on the 2 parts of the aortic wall. Then the distal anastomosis with the aorta was completed. After the restoration of cardiac activity with a partial clamp of vascular prosthesis proximal anastomoses of venous grafts were implanted. The postoperative period was uneventful.