Radim Brát

Hybrid Techniques for Complex Aortic Surgery

Abstract The use of hybrid techniques in the treatment of complex aortic artery diseases is based upon combination of surgical techniques, the advantages of which are verified good long-term results, and endovascular techniques, which are associated with a decrease of the surgical risk for the patient. These hybrid techniques are used for the treatment of thoracic aortic diseases in situations, when parts of the aorta with significant branches, as well as adjacent part of the aorta without such branches, are affected with the pathological process. The most frequent scenario for the use of hybrid techniques thus is a combination of the aortic arch and descending aorta disease or pathology of the descending aorta including abdominal part. Most frequently performed hybrid procedures in the area of thoracoabdominal aorta are arch debranching, stented elephant trunk, frozen elephant trunk, and visceral debranching. In the following text, the principle and surgical technique are listed for every type of the procedure, together with main advantages and disadvantages. Also, we present a detailed analysis of treatment outcomes published in the literature. Due to the fact that long-term outcomes are not known for any of these techniques on a representative patient cohort, they cannot be considered a method of first choice and they do not replace a radical surgical resection procedure. Nevertheless, the presented procedures represent a new and perspective method, which broadens the possibilities of treatment of thoracic aortic diseases in patients, who are not suitable for radical surgical treatment.

The Impact of Endoscopic Harvesting Methods on Graft Patency in CABG Patients

Endoscopic harvesting of venous grafts (EVH) is a progressive and developing technique in the area of surgical treatment of ischemic heart disease. The main reason for the increasing frequency of its use is the decrease of postoperative pain, lower rate of early infectious complications, lesser swelling of the operated extremity, lower incidence of haematomas, earlier mobilization of the patient, and greater patient satisfaction with the cosmetic effect. These advantages of EVH have been repeatedly confirmed in numerous studies, and it may be regarded as undisputable that, as far as short-term outcomes are concerned, EVH is much better than open vein harvesting (OVH). As far as medium-term results are concerned, at present we have a sufficient number of studies proving comparable results of EVH and OVH. The main controversy persists regarding the long-term results of the EVH technique, where we lack a sufficient amount of data in order to be able to prove identical or better outcomes of EVH, when compared with the OVH technique.