International Medical Journal, Vol. 26., Iss. 4, 2020, P. 29−32.
PREVENTION OF INTRAOPERATIVE COMPLICATIONS IN PATIENTS WITH ACUTE AORTIC SYNDROME
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Among the methods of treatment of acute aortic pathology in many cases, the surgery remains the method of choice. In order to improve the results of treatment for the patients with acute aortic syndrome by reducing the number of acute intraoperative lesions of organs and systems, a study was conducted, wherein there were analyzed the results of surgical treatment of 166 patients with thoracic and / or abdominal aortic lesions. The advantages of the developed and implemented in practice diagnostic and treatment algorithm for such patients in the pre−, intra− and postoperative periods have been considered. Upon admission to clinic, the main tasks were the maximum elucidation of the diagnosis and rapid structuring of surgery, which were started as soon as possible, primarily to control the blood loss. Hardware reinfusion of all blood lost from aortic rupture was mandatory. The most significant systemic complications were determined by cardiac, renal, respiratory and neurological ones. The proposed diagnostic and treatment algorithm has been concluded to be able of reducing the time and increase of the care efficiency for this category of patients. Programmed and systematic prevention of the most common and most dangerous intraoperative complications of acute aortic syndrome prevents their occurrence, reduces severity, improves the treatment outcomes. Intraoperative autohemotransfusion can reduce the total volume of blood loss, volume of infusion of donor drugs, and, consequently, frequency of acute kidney and lung injury in the intra− and early postoperative periods. The overall results of treatment for the patients with acute aortic syndrome largely depend on the experience of medical staff and equipment of a specialized hospital.
Key words: aorta, acute aortic syndrome, aortic aneurysm, aortic dissection, surgical treatment, autohemotransfusion.
1. Bogopol'skaya O. M. Klinicheskie osobennosti anevrizm i rassloeniya aorty. Obzor // Kardiologiya. 2002. № 42 (10). S. 95−101.
2. Pomianowski P., Elefteriades J. A. The genetics and genomics of thoracic aortic disease // Ann. Cardiothorac. Surgery. 2013. Vol. 2 (3). P. 271−279. doi: 10.3978/j.issn.2225−319X.2013.05.12
3. Estimation of global and regional incidence and prevalence of abdominal aorticaneurysms 1990 to 2010 / U. Sampson et al. // Global Heart. 2014. Vol. 8. P. 159−170. doi: 10.1016/j.gheart.2013.12.009
4. Clinical presentation, management, and short−term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection / M. Di Eusanio et al. // J. Thorac. Cardiovasc. Surg. 2013. Vol. 145. P. 385−390. doi: 10.1016/j.jtcvs.2012.01.042
5. Batushkin V. V. Rasslaivayushchaya anevrizma aorty. Realii i vozmozhnosti // Kardiologiya: ot nauki k praktike. 2014. № 2. S. 94−114.
6. The shortfall in long−term survival of patients with repaired thoracic or abdominal aortic aneurysms: retrospective case−control analysis of hospital episode statistics / A. Karthikesalingam et al. // Eur. J. Vasc. Endovasc. Surg. 2013. Vol. 46. P. 533−541. doi: 10.1016/j.ejvs.2013.09.008
7. Duzhii І. D., Gres'ko І. Ya., Kravets' O. V. Atipovii perebіg rozsharuvannya aorti // Ukr. pul'monologіch. zhurn. 2015. № 1. S. 70−72.
8. Uspeshnoe lechenie s sindromom vtorichnoi poliorgannoi nedostatochnosti, razvivsheisya posle ekstrennogo protezirovaniya grudnoi aorty pri ee rassloenii / Yu. V. Belov i dr. // Kardiologiya i serdechno−sosudistaya khirurgiya. 2010. № 3 (1). S. 71−74.
9. Mortality in patients with acute aortic dissection type A: analysis of pre− and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A(GERAADA) / L. O. Conzelmanna et al. // Eur. J. Cardio−Thoracic Surg. 2016. Vol. 49. P. 44−52. doi: 10.1093/ejcts/ezv356