RESULTS OF SURGICAL TREATMENT OF THE BRACHIOCEPHAL TRUNK


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Abstract

Intrathoracic reconstructions for atherosclerotic lesions of the brachiocephalic trunk have proven to be interventions that provide long-term patency and freedom from neurological deficits and, today, are considered the operation of choice for such lesions.

Purpose: to evaluate the hospital results of surgical treatment of brachiocephalic trunk.

Materials and methods. The study included 79 patients with atherosclerotic lesion of the brachiocephalic trunk. who were treated at the Vishnevsky National Medical Research Center for Surgery in the period from 1983 to 2020.

Results. Hospital results: stroke - 4 (5.06%), prosthesis thrombosis - 3 (3.9%), bleeding - 4 (5%), mediastinitis - 6 (7.5%), AMI - 4 (5%), lethality - 3 (3.9%).

Thrombosis of the prosthesis during the hospital period was observed in patients who underwent closed endarterectomy from the bifurcation of the brachiocephalic trunk: with linear prosthetics in two cases (2.6%), with double bifurcation prosthetics in one case (1.3%). Bleeding in all 4 cases (5%) was observed from the sternum and soft tissues, eliminated after resternotomy and revision of the p/o wound. Hospital mortality was 3.9%: in one case (1.3%) due to mediastinitis, and in two (2.6%) due to stroke. Only the development of prosthesis thrombosis (p=0.006) significantly influenced the occurrence of neurological deficit in the n/o period - in 2 out of 3 cases of prosthesis thrombosis, a stroke occurred in the right hemisphere.

It should be noted that since 2001, there have been no cases of thrombosis, AMI and mediastinitis. In the first case, in our opinion, this is due to the refusal of endarterectomy from the bifurcation of the brachiocephalic trunk with linear prosthetics. In the second - an assessment of cardiac risk based on the results of coronary angiography or stress echocardiography. If necessary, the first step was myocardial revascularization, and then intrathoracic reconstruction. And, finally, we associate the absence of cases of mediastinitis with the transition from complete median sternotomy to partial, which provides optimal visualization and exposure in the surgical wound, and also, due to low trauma, reduces the risk of postoperative complications.

Conclusion. Thus, to date, brachiocephalic trunk prosthetics has proven itself in the practice of cardiovascular surgery as a safe and reliable technique that provides acceptable hospital results, as well as long-term patency and freedom from neurological deficits.

Full Text

Intrathoracic reconstructions for atherosclerotic lesions of the brachiocephalic trunk have proven to be interventions that provide long-term patency and freedom from neurological deficits and, today, are considered the operation of choice for such lesions.

Purpose: to evaluate the hospital results of surgical treatment of brachiocephalic trunk.

Materials and methods. The study included 79 patients with atherosclerotic lesion of the brachiocephalic trunk. who were treated at the Vishnevsky National Medical Research Center for Surgery in the period from 1983 to 2020.

Results. Hospital results: stroke - 4 (5.06%), prosthesis thrombosis - 3 (3.9%), bleeding - 4 (5%), mediastinitis - 6 (7.5%), heart attack - 4 (5%), mortality - 3 (3.9%).

Thrombosis of the prosthesis during the hospital period was observed in patients who underwent closed endarterectomy from the bifurcation of the brachiocephalic trunk: with linear prosthetics in two cases (2.6%), with double bifurcation prosthetics in one case (1.3%). Bleeding in all 4 cases (5%) was observed from the sternum and soft tissues, eliminated after resternotomy and revision of the p/o wound. Hospital mortality was 3.9%: in one case (1.3%) due to mediastinitis, and in two (2.6%) due to stroke. Only the development of prosthesis thrombosis (p=0.006) significantly influenced the occurrence of neurological deficit in the n/o period - in 2 out of 3 cases of prosthesis thrombosis, a stroke occurred in the right hemisphere.

It should be noted that since 2001, there have been no cases of thrombosis, heart attacks and mediastinitis. In the first case, in our opinion, this is due to the refusal of endarterectomy from the bifurcation of the brachiocephalic trunk with linear prosthetics. In the second - an assessment of cardiac risk based on the results of coronary angiography.  If necessary, the first step was myocardial revascularization, and then intrathoracic reconstruction. And, finally, we associate the absence of cases of mediastinitis with the transition from complete median sternotomy to partial, which provides optimal visualization and exposure in the surgical wound, and also, due to low trauma, reduces the risk of postoperative complications.

Conclusion. Thus, to date, brachiocephalic trunk prosthetics has proven itself in the practice of cardiovascular surgery as a safe and reliable technique that provides acceptable hospital results, as well as long-term patency and freedom from neurological deficits.

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About the authors

Dmitriy Polyansky

НМИЦ хирургии им. А.В. Вишневского

Author for correspondence.
Email: polyanskydmitriy@yandex.ru
ORCID iD: 0000-0003-3077-8801
SPIN-code: 5250-2057
Russian Federation

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