A case series of rare pathologies of the aorta and the aortic arch in adolescents and younger adults: Transfer of experience for an individualized approach

Objective: While aneurysm of the aortic root, interrupted aortic arch, and aortic coarctation are the most frequent aortic diseases in adolescents and younger adults, there are a number of rare pathologies of the thoracic aorta that need individualized treatment. Patients: We present a small case series of unusual aortic pathologies in patients presenting with a broad spectrum of symptoms: tiredness, dysphagia, dyspnea, arterial hypertension, renal failure, and claudication. (1). Segmental agenesia of the descending aorta. (2). Balanced double aortic arch with complete vascular ring. (3). Right descending aortic arch, left lusorian artery with Kommerell diverticulum. (4). Large patent ductus (2.5 cm) and ventricular septal defect. (5). Aneurysm of the aortic arch in the presence of tuberous sclerosis. (6). Pseudo-aneurysm of the proximal descending aorta following coarctation patch plasty. (7). Supravalvular aortic stenosis combined with severe aortic valve stenosis. (8). Pseudo-aneurysm following ascendens-to-descendens bypass because of recurrent coarctation. (9). Takayasu arteriitis with severe stenosis in the thoraco-abdominal aorta. Results: The following procedures were performed, using individualized cardiopulmonary bypass, canulation and cerebral protection strategies. (1). Ascending to supraceliac extra-anatomic bypass. (2). Division of the ductus ligament and of the anterior aortic arch distally to the left subclavian artery. (3). Excision of the Kommerell diverticulum and translocation of the left subclavian artery. (4). Patch closure of the aorto-pulmonary window (patent ductus) and closure of the ventricular septal defect. (5). Complete aortic arch replacement combined with debranching of the supra-aortic vessels. (6). Graft interposition of the proximal descending aorta. (7). Enlargement of the ascending aorta and aortic valve replacement. (8). Exclusion of the pseudo-aneurysm, end-to-side graft interposition. (9). Ascending aorta to infrarenal aorta or ascending to bi-iliac artery bypass (planned). All patients were operated on without operative mortality. One patient died in-hospital from pulmonary complications one week after surgery. One patient is still awaiting surgery. All other patients recovered very well from the operation and did not show any residual symptoms. Conclusion: Rare pathologies of the thoracic aorta in younger patients may cause a broad spectrum of unusual symptoms; in some of them, diagnosis is delayed. Cross-sectional imaging is mandatory for optimal operative planning Surgical treatment can be performed with very satisfying results. The prognosis of these patients is usually favorable following surgery. Keywords: adolescents; aortic arch; ascending aorta; cerebral protection; circulatory arrest; results; surgery; younger adults

Results of Off-Pump Coronary Artery Bypass Surgery in Patients with EuroSCORE≥5

Background: The lack of reliable data on the possibility, safety and results of OPCABG in patients with high surgical risk hinders the further wide introduction into clinical practice of such operations. In this regard, conducting a comparative evaluation of the results of OPCABG in patients with low and high surgical risk seems to us a worthwhile project. Materials and Methods: During the period between 2015 and 2017, 310 OPCABG operations were performed. Patients were divided into 2 groups depending on the EuroSCORE risk calculator value. Group 1 consisted of 130(41.9%) patients with a high surgical risk (EuroSCORE≥5), and Group 2 consisted of 180(58.1%) patients with a low surgical risk (EuroSCORE<5). Results: We could not find between the two groups significant differences in the number of mean grafts per patients (3.12 in Group 1 and 3.13 in Group 2), in operation times, or in the level of morbidity and mortality (1.5% in Group 1 and 1.2% in Group 2). All intraoperative conversions to on-pump CABG (5 cases or 3.8%) occurred in patients of Group 1 (P=0.008). Conclusion: The OPCABG operation in patients of high-risk group is a safe method and can be performed without compromising the completeness of myocardial revascularization with the same low mortality as in low-risk patients. The most common type of complication in high-risk patients is on-pump conversion, which at earlier and planned implementation is not reflected significantly at the level of hospital mortality

Effects of the Presence of Left Main Coronary Artery Disease on the Results of Off-pump Coronary Artery Bypass Grafting Surgery

Background: Left main coronary artery (LMCA) disease is one of the risk factors that affect the outcomes of coronary artery bypass grafting surgery. In particular, this risk factor pertains to the conduct of conventional on-pump CABG. Very little is known about the effects of the presence of LMCA disease on the results of off-pump CABG (OPCABG) surgery. Material and Methods: In the Department of Cardiac Surgery of the Republican Specialized Center of Cardiology, during the period between April 2015 and April 2017, 270 consecutive OPCABG procedures were performed. Patients were divided into 2 groups depending on the presence or absence of LMCA disease. Group 1 consisted of 124(44.9%) patients with LMCA disease, and Group 2 consisted of 146(55.1%) patients without LMCA lesions (non-LMCA group). Results: The average number of distal anastomoses in both groups was more than 3 anastomoses/patient. The incidence of nonfatal intraoperative complications was 8.9% in Group 1 and 15.1% in Group 2 (P=0.1212). The conversion rate to on-pump CABG amounted to 3.2% (4 patients) in Group 1 and to 4.8% (7 patients)in Group 2. In the immediate postoperative period, 40(32.2%) patients of Group 1 and 45(30.8%) of Group 2 needed inotropic support until full restoration of normal hemodynamics with duration between 3.0 and 2.6 hours. The average duration of ventilation support was 6.4 hours in Group 1 and 5.6 hours in Group 2. Hospital mortality was 0.8% (1 patient) in Group 1 and 0.7% (1 patient) in Group 2 (P>0.05). Conclusion: Thus, the presence of left main stem lesion of LCA is not an additional risk factor that would complicate the performance of OPCABG surgery. The OPCABG operation in this group of patients is a safe method and can be performed without compromising the completeness of myocardial revascularization with the same low mortality as in low-risk patients