Wrapping technique of ascending aorta in Hybrid procedure for complex aortic arch disease

Abstract

Background: The hybrid procedure proved to be very suitable for Vietnamese conditions in the treatment of complex aortic diseases in the arch and on supra-renal lesion. There is a difficult situation when the ascending aorta is more dilated than can be accommodated by stent-grafts. Wrapping techique is a solution to this situation. Methods: Report on a clinical case of successful application of aortic wraping technique to treat complex aortic cross injuries at Cardiovascular and Thoracic Center, Viet Duc University Hospital. Results: A 73-year-old female patient was admitted to the hospital because of sudden chest pain. History of high blood pressure, heart failure, dyslipidemia and hypothyroidism. MSCT revealed type B aortic dissection, left hemothorax complication, the entire ascending aorta and a part of cross dilated to 50mm (maximum stent-graft size is 46mm). Poor general condition, severe and complicated acute aortic injury, if the classic surgery requires total thoracic aorta replacement – ​​the risk of death is very high, so the hybrid solution is a reasonable choice if having the solution is to solve the problem to create a landing zone for stent-graft. Hybrid surgery was started with open sternotomy, bilateral aortic - carotid bypass with Dacron prothesis 9mm, using a large artificial vessel to wrap around the ascending aorta to reduce the medium size to 38mm. Drain and close the sternum. Next is endovascular intervention – installing a stent-grafts of 42x42x200 and 42x38x150 then 38x34x150 to the diaphragm, plug for left subclavian artery. Left pleural drainage. The patient was discharged 10 days after surgery. Follow-up after 2 years for good results. Conclusion: The hybrid procedure can still be applied in the situation of ascending aorta dilatation with wrapping technique – decreasing the size of the aorta to fit the size of the stent-graft in some high-risk situations. with classic surgery.