Authors

• Igor Rudež — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-7735-6721
• Josip Varvodić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6602-699X
• Davor Barić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5955-0275
• Daniel Unić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2740-4067
• Robert Blažeković — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-7125-361X
• Mislav Planinc — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-9833-832X
• Marko Kušurin — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5690-9924
• Michael Markin — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2478-9192
• Savica Gjorgjievska — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-4304-1852
• Željko Sutlić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6926-9436

Keywords

E-vita, aortic aneurysm

DOI

Full Text

**Introduction**: Extensive aortic pathology with concomitant valvular disease is a challenge for the surgeon. Careful and detailed planning of procedures and thorough preoperative diagnostics are essential for the outcome. (1, 2) **Case report:** We present a case of a 45-year-old male who is under cardiologist control since early childhood and was operated due to aortic coarctation at the age of nine. He presented to the emergency room with chronic heart failure symptoms. MSCT angiography showed aneurysm of descending aorta 88mm x 85mm and stenosis of the arch proximal to the left subclavian artery up to 22 mm. Transthoracic/transoesophageal echocardiography revealed EF 40%, LA 5.1 cm, LVd 6.2 cm, LVs 5 cm, aortic valve bicuspid, sclerotic PPG 41 mmHg, MPG 29 mmHg, area 1.2 cm2 AR 2+, MR 3+ VC 6mm, TR trace. Elective surgery was planned. Under direct visualization a size 24 E-vita open plus stent graft (JOTEC GmbH, Germany, Hechingen) was deployed, aortic arch was replaced with the vascular part of the E-vita open plus, and supraaortic branches were reimplanted using the island technique in circulatory arrest (55 min) with bilateral antegrade cerebral perfusion and moderate hypothermia (28°C). Aortic valve replacement (Carbomedics Mechanical 21), mitral valve repair (Carpentier Edwards Physio II ring 30 mm), tricuspid valve repair (Edwards MC3 Tricuspid Annuloplasty System 30 mm) were done respectively. Left carotido-subclavian bypass was performed to ensure better landing zone for the Evita open plus stent graft (zone II). The patient recovered well from surgery and postoperative ECHO has shown normal function of valves with perfect position of the stent graft with complete exclusion of the aneurysm from circulation. The patient was discharged home seven days after surgery, and was without complications after three months follow up. **Conclusion**: Detailed planning of extensive cardiac surgery procedure can predict successful outcome.

Literature

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2. Greenberg RK, Haddad F, Svensson L, O’Neill S, Walker E, Lyden SP, et al. Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion. Circulation. 2005;112(17):2619–26. https://doi.org/10.1161/CIRCULATIONAHA.105.552398