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    IMPACT OF CEREBRAL PERFUSION STRATEGIES ON NEUROLOGICAL OUTCOMES IN AORTIC ARCH REPAIR USING THE FROZEN ELEPHANT TRUNK TECHNIQUE
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2025-07-18)
    Shokarovski, Marjan
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    Mehmedovic, Nadica
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    Grazhdani, Sonja
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    Grueva, Elena
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    This study aimed to evaluate the impact of various cerebral perfusion strategies on neurological outcomes, comparing our results on trilateral antegrade cerebral perfusion (tACP) to reported rates from latest literature analysis on bilateral antegrade cerebral perfusion (bACP) and unilateral antegrade cerebral perfusion (uACP). Methods: A retrospective analysis was performed on 15 patients who underwent surgical intervention at the University Clinic for Cardiac Surgery in Skopje between 2018 and 2023. All patients included had elective chronic aortic dissections. Preoperative evaluation encompassed a detailed medical history, physical examination, diagnostic imaging, and risk stratification using the EuroSCORE II model. Standardized surgical techniques, including trilateral cerebral perfusion, were employed intraoperatively. The primary endpoint was the incidence of major neurological complications, including stroke and SCI, while the secondary endpoint was all-cause mortality. Results: Major neurological events, including stroke and transient ischemic attack (TIA), were observed in 6.7% of patients, with SCI occurring in a single case (6.7%). These rates are notably lower than previously reported figures of 5-15% for procedural strokes following complex aortic arch repairs employing uACP or bACP. All-cause mortality in our cohort was 20%, compared to the 31% reported in the literature for patients undergoing open aortic arch repair. Conclusion: In patients undergoing total aortic arch repair with the FET technique, tACP appears to be a viable strategy for cerebral and spinal cord protection. The complication rates observed in our cohort are favorable and support further investigation with larger patient populations to validate these findings.
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    Multistage Hybrid Treatment of Aortic Aneurysm and Management of Postoperative Complications: A Case Report
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2025-06-01)
    Shokarovski, Marjan
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    Mehmedovic, Nadica
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    Grazhdani, Sonja
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    Grueva, Elena
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    The Frozen Elephant Trunk (FET) is a surgical procedure developed for simultaneous repair of the aortic arch and the proximal descending thoracic aorta. Experience has shown its technical feasibility and good clinical results, although complications remain possible. Case Presentation: A 66-year-old male presented for evaluation due to findings from computed tomography angiography of aneurysms in the ascending aorta, aortic arch, and abdominal aorta. The patient had a history of a quadruple coronary artery bypass graft (CABG) and placement of two stents in the descending thoracic aorta, which were improperly aligned, thrombosed, and further complicated the case. The patient underwent surgery involving sternotomy to perform the FET procedure, replacing the ascending aorta and aortic arch and placing a stent graft in the proximal descending thoracic aorta. Simultaneously, two coronary artery bypass grafts were performed. Postoperatively, the patient was stable, and the intervention outcome was satisfactory. Subsequently, endovascular treatment was carried out on the remaining thoracic aorta and abdominal blood vessels. However, respiratory failure necessitated the placement of stent grafts in the left main bronchus on two occasions. Despite extensive efforts, the patient succumbed to respiratory insufficiency. Conclusion: Timely intervention and a multidisciplinary approach played a key role in addressing complications, although the patient ultimately experienced a fatal outcome due to multiorgan failure.
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    SINGLE-STAGE TREATMENT OF ANEURYSM OF THE DISTAL AORTIC ARCH AND PROXIMAL DESCENDING AORTA USING THE FROZEN ELEPHANT TRUNK PROCEDURE. CASE REPORT
    (Macedonian Academy of Sciences and Arts / Sciendo, 2020-03)
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    Marjan Shokarovski
    ;
    Stefanija Hadzievska
    ;
    Nadica Mehmedovic
    Aneurysms of the thoracic aorta involving the distal arch and the proximal descending aorta have traditionally been treated with two open procedures. During the first stage, the aortic arch pathology has been addressed through a median sternotomy. Several weeks or months later, a second stage followed and included completing the repair of the descending aorta through a lateral thoracotomy. We, herein, report a single stage repair of an aneurysm involving the distal aortic arch and the proximal descending aorta using the frozen elephant trunk operative technique. Vascular hybrid stent graft prosthesis, specifically designed for treatment of extensive aortic aneurysms, has been used to replace the arch component and exclude the descending aorta component of the aneurysm through a median sternotomy, using bilateral antegrade cerebral perfusion and mild systemic hypothermia for intraoperative organ protection.