kamentsidis dimitrios md, fetcs cardiac surgeon st. luke’s ... · the coronarography confirmed...

Kamentsidis Dimitrios MD, FETCS Cardiac Surgeon, St. Luke’s Hospital

Patient

Male 67 years old

HBP

Diabetes NID

Smoker (stopped 7 years ago)

CABG ( LIMA, RIMA), 7 years ago

Abdominal Aorta Aneurysm, 7 years ago

(Endovascular repair)

Asymptomatic

Incidental discovery

Aortic Arch Aneurysm 6,7 cm

Conventional Surgery , Extra-corporal Circulation ,

Hypothermia

(Euroscore II 21,9%)

Branched stent-graft

(No, because of the age and the rapid evolution of the

illness)

Hybrid Treatment

(Supraortic Debranching + Endoprothesis)

Because of the proximity of the aneurysm to the Left Subclavian Artery and in order to achieve landing zone over 2 cm it was decided a Total SupraaorticDebranching

The coronarography confirmed patency of the LIMA RIMA grafts( in order to avoid myocardial ischemia we should maintain constant flow to the LSA and RSA)

It was decided an one-stage procedure of two steps off-pump Total Supraaortic Debranching + right trans-femoral stent graft

Avoid the use of Extra-corporal Circulation

Avoid Hypothermia

Minimizing the danger of Neurological damage

BUT

Very demanding procedure because of the previous CABG and the presence of patent LIMA RIMA

Danger of Myocardial Ischemia

General anesthesia/ Left and Right Radial arterial lines

Midline Sternotomy

Symphisiolisis - exposure Ascending Aorta

exposure Supraaortic Vessels at their origin

Proper positioning of the stent graft

Patent Supraaortic Grafts

Patent LIMA, RIMA

Uneventful

Two days in the ICU

Four days to the ward

Discharged 6th PO day

Three months follow-up

Clinically well

CT-scan

Exclusion of the aneurysm

Patent debranching Grafts (Supraaortic)

Total exclusion of the aneurysm

Thrombosis of the aneurysmal sac (No Endoleaks)

MERCI BEAUCOUP !!!