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.