Results of Coronary Stenting using the Stents with

Интервенционная Cardiovascular ангиология
surgery
Fig. 5. Second stage — left-sided carotid-subclavian bypass grafting,
endovascular grafting of the aortic arch and the descending aorta
Fig. 6. Postoperative MHCT of patient A
Fig. 7. MHCT-aortography of patient Z. after the 2nd stage of
intervention
arch replacement with an endograft
were performed (Fig. 5).
The first stage (October 4, 2010):
the heart was approached through
median sternotomy. A T-shaped
aortotomy was performed above the
sinoaortic area. The revision showed
the dissection starting from the
level of aortic valve’s commissures,
spreads into the anterior, lateral and
posterior aortic walls involving the
right coronary artery ostium, and
then spreads into the aortic arch in
the shape of a two-barreled gun. The
button-like isolation of the coronary
ostia was performed for subsequent
implantation. The valve’s cusps
were sectioned. The aortic valve and
the ascending aorta were replaced
by a valved conduit Carbomedics
Inc. (aortic valve prosthesis 25, graft
diameter 28). The right and the left
coronary arteries were reimplanted
onto the conduit. The revision of the
aortic arch revealed that the dissection
spreading in the upper wall of
the aorta, ends by a fenestration at
the level of brachiocephalic trunk;
the dissection involving the posterior
and the lateral walls spreads into
the arch and ends in the area of the
left subclavian artery ostium. The
aortic arch branches arise from the
true lumen. The aortic arch was sectioned
in oblique way, with the preservation
of the upper wall and a part
of lateral walls. The false lumen was
eliminated and the distal anastomosis
line was reinforced with internal
and external padded sutures (the
“layered cake”). The distal anastomosis
between the conduit and the
aorta was performed using the open
technique.
The second stage (October 7,
2010): the procedure was performed
under endotracheal anesthesis.
The approach to the left
common carotid artery and the left
subclavian artery was achieved
through the supraclavicular incision.
An “end-to-side” anastomosis
was performed between the
subclavian artery and the common
carotid artery. Simultaneously an
introducer was inserted into the
left common femoral artery; on the
right the introducer was inserted
percutaneously. The diagnostic
catheters were advanced by
50
(№ 26, 2011)