eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2022
vol. 19
 
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abstract:
Original paper

Multidisciplinary aortic arch procedures within the “Aortic Team”

Tomasz Jędrzejczak
1
,
Pawel Rynio
2
,
Maciej Lewandowski
3
,
Andrzej Żych
1
,
Anita Rybicka
4
,
Maciej Żukowski
5
,
Arkadiusz Kazimierczak
2

  1. Cardiac Surgery Department, Pomeranian Medical University, Szczecin, Poland
  2. Vascular Surgery Department, Pomeranian Medical University, Szczecin, Poland
  3. Cardiology Department, Pomeranian Medical University, Szczecin, Poland
  4. Faculty and Department of Nursing, Pomeranian Medical University, Szczecin, Poland
  5. Department of Anaesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland
Kardiochirurgia i Torakochirurgia Polska 2022; 19 (1): 11-15
DOI: https://doi.org/10.5114/kitp.2022.114549
Online publish date: 2022/03/24
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Introduction and aim
The European societies EACTS (European Association for Cardio-Thoracic Surgery) and ESVS (European Society for Vascular Surgery) recommend the establishment of “Aortic Teams” from 2019. In Poland, the first such team was officially established in Specialist University Hospital no. 2 in Szczecin in 2021.

Material and methods
Sixty-four patients were treated for aortic arch pathology using frozen elephant trunk (n = 3), branch custom made devices (n = 12), physician-modified endo-grafts (PMEG; n = 30) and the thoracic endovascular aortic repair “plus” technique (n = 19).

Results
Among thoracic endovascular aortic repair (TEVAR) plus (chimneys/periscopes, n = 7, extra-anatomical bypasses, n = 12) there was 100% technical success and 4% bad outcomes (stroke or death). Among “customized” stent grafts there were Bolton Relay (n = 8), Brail Endo-Branch (n = 1) and Castor branched stent graft (n = 3) with 91% technical success and 18% bad outcomes. In the group of PMEG there were 14 cases with one fenestration, 5 cases with two fenestrations and 11 cases with triple fenestration to all vessels of the aortic arch. In this group, technical success was achieved in 91% and poor outcome ended treatment in 11%. In total we noted a 91% technical success rate and a good treatment outcome was achieved in 89%. The cooperation of cardiac surgeons and vascular surgeons in one team brought competence benefits for both specialties. It allowed for good clinical and economic results despite new logistical complexities and fits into the currently changing perspective of cardiac surgery development worldwide.

Conclusions
Implementation of the recommendation to create aortic teams within cardiac surgery departments is possible and may be cost-effective in Polish conditions.

keywords:

aortic team, frozen elephant trunk, f/bTEVAR
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