Aim. To analyze the efficacy and safety of the percutaneous transfemoral puncture technique for TEVAR (thoracis endovascular aortic repair).Material and methods. The retrospective study included 89 patients with aortic pathologies, for whom endovascular repair was performed: 51 patients (57%) with aortic dissection (type I DeBakey — 30 cases (58,8%) and type III — 21 (41,2%)), 38 (43%) patients with aortic aneurism. 82% of patients were male, the median age was 57 years (minimum age 17 years, maximum age 75 years). All patients were divided into two groups: in the first group (48 patients) endovascular aortic repair was performed under endotracheal anesthesia with open femoral exposure of the common femoral artery (CFA), in the second group (41 patients) — by percutaneous puncture method under local anesthesia. Technical and clinical aspects of procedures were analyzed.Results. Technical success of endovascular repair was achieved in 100% cases in both groups. The duration of the operation in the group with percutaneous access was statically significantly shorter (120 (94-150) minutes vs 87(60-120) minutes, p=0,001). Also, the time spent by patients in the intensive care unit and the period of hospitalization (18 (14-22) hours versus 1 (0-3) hours, p=0,001; 5 (4-6) days versus 4 (3-5) days, p=0,03) was shorter. In the open access group 2 (4,2%) patients developed access-related complications - acute thrombosis of the common femoral artery and hematoma of the postoperative wound, which required additional surgical aid - thrombectomy from the CFA, the second patient had evacuation of the hematoma of the postoperative wound. Cite-related complications in the second group were not observed. No major complications including neurological deficits and hospital mortality were observed in both groups.Conclusions. Thoracic endovascular aortic repair (TEVAR) using percutaneous access under local anesthesia in stable patients has proven to be safe and effective. The operation time is significantly reduced and this approach in most cases eliminates the need for the patient to stay in the intensive care unit in the early postoperative period. Possibility of early mobilization of the patient appears with reducing of the duration of hospitalization.
Транскатетерная имплантация аортального клапана (TAVI) несет риск внутрипроцедурных осложнений, которые в конечном итоге могут потребовать неотложной кардиохирургической операции. Одним из таких осложнений является разрыв корня аорты, потенциально смертельное осложнение. Достаточно сложно определить причины и предикторы, приводящие к данному осложнению, так как частота его встречаемости не превышает 1,1%. Представлен клинический случай разрыва корня аорты во время TAVI.Финансирование. Исследование не имело спонсорской поддержки.Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.Для цитирования: Кондратьев Д.А., Чернов И.И., Гапонов Д.П., Энгиноев С.Т. Клинический случай разрыва корня аорты при транскатетерной замене аортального клапана // Клиническая и экспериментальная хирургия. Журнал имени ака-
Aim: the purpose of this publication is to demonstrate the safety and efficacy of the endovascular method of treatment for long-existing, neglected, and fairly common congenital heart defects such as an atrial septal defect with high pulmonary hypertension.Material and Methods. We present a clinical case of the successful X-ray endovascular treatment of a 48-year-old female patient with a high pulmonary hypertension diagnosed with congenital heart disease, atrial septal defect. Clinical and instrumental examination included standard resting electrocardiography, echocardiography, and catheterization of the right heart and the pulmonary artery. Surgical treatment consisted in an X-ray endovascular implantation of the 40-mm atrial septal defect closure device via the transfemoral access. Post-operative follow up care lasted for 15 months.Results. Echocardiography study showed the left ventricular ejection fraction of 53 mL; congenital heart disease was characterized by 2.5-cm secondary central atrial septal defect and a variable pressure release. Pulmonary artery systolic pressure was 120 mmHg. Catheterization of the right heart and the pulmonary artery showed blood flow with the presence of leftto-right shunting equal to Qp/Qs=2.0/1. An X-ray endovascular atrial septal defect surgery was conducted in an X-ray operation room via a standard transfemoral access. The surgery consisted in X-ray endovascular atrial septal defect occlusion with an implantation of an atrial septal defect closure device with 40-mm neck diameter. Intraoperative echocardiography study showed that the closure device was placed correctly with no signs of residual bleeding. The final echocardiography performed in three days showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 83 mmHg. Hospital stay lasted for three days. Follow-up echocardiography study at 15 months showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 46 mmHg.Conclusion. There are currently two types of treatment: open surgery such as suturing or plastic urgery with extracorporeal blood circulation and X-ray endovascular occlusion of the atrial septal defect by implantation of a special device. The X-ray endovascular treatment of an atrial septal defect with a closure device implantation is a highly effective and safe procedure. The main advantages of this method are as follows: surgery does not require anesthesia, incision, and heart-lung bypass whereas reimplantation and repositioning of the device is always feasible.
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