Hybrid surgery of the thoracic aorta: theory and practical aspects

Résumé fourni par la source

Since the invention of the cardiopulmonary bypass in the 50s, the aortic surgery has made extraordinary progress. Despite many improvements and innovations, that surgery remains a real challenge for cardiovascular surgeons. The related mortality of such procedures remains above 15% for elective procedures and over 60% in emergency. In addition to this mortality, the aortic surgery is also related to a heavy morbidity (infection, kidney or respiratory failures, hepatic dysfunction, etc..). In the same time, since 1998, reliable aortic stentgrafts allow to treat more and more complex aortic diseases in patients increasingly old and sick. For many years, the endovascular approach was limited at the descending thoracic aorta and the infrarenal part of the abdominal aorta. However, many surgeons saw the potential of such techniques in the treatment of complex thoracic or thoracoabdominal lesions. Except research protocols, all available stentgrafts have no branch, allowing for example the covering of lesions of the horizontal aorta or to exclude aortic lesions in front of visceral arteries. In order to treat less invasively these complex lesions, surgeons have introduce the concept of “Hybrid Surgery”, combining conventional and endovascular procedures. At the beginning, they could only cover the distal aortic arch, performing the transposition of the left subclavian artery; nowadays, we can perform complex transpositions of all supra-aortic vessels, allowing the complete coverage of the horizontal aorta. Originally reserved for scheduled procedures, this approach can also be employed for increasingly complex aortic lesions, even in emergency. Mots cles Procedure Hybride Aorte Thoracique Endoprothese Chirurgie

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