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CURRENT ISSUE

№3' 2021

SURGERY

International Medical Journal, Vol. 27., Iss. 3, 2021, P. 19−23.


DOI (https://doi.org/10.37436/2308-5274-2021-3-4)

METHODS OF DIAGNOSIS AND RESULTS OF SURGICAL TREATMENT OF ASCENDING ANEURYSMS AND AORTIC ARCH


Kravchenko V. I., Kravchenko I. M., Libavka V. D., Lazorishinets V. V.

SI Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine

Treatment of ascending and aortic arch aneurysms (or just aorta) is the most difficult problem of cardiovascular surgery, due to the need to correct the underlying pathology and adequate protection of the brain and visceral organs. To determine the methods of surgical treatment of aneurysms, the nature and frequency of post−surgery complications and treatment results, a study was conducted at the basis of the Amosov National Institute of Cardiovascular Surgery, wherein 419 patients were operated since 1994 to 2018. Aneurysms were diagnosed based on clinical data, transthoracic and esophageal echocardiography, computed tomography, X−ray examination, aortography. All surgeries were performed under general anesthesia, through midline sternotomy and with the use of an artificial circulation device, as well as under conditions of deep or moderate hypothermia. In all cases, retrograde cerebral perfusion, antegrade selective perfusion of brachiocephalic arteries with preserved perfusion through the femoral artery of the visceral organs and lower extremities, or circulatory arrest were used to protect the brain and visceral organs. For the correction of main defect, valve−saving technique with resuspension / plastic of the aortic valve and prosthesis of the semicircle / arch was used; Bentall operation with semi−arc / arch prosthesis, hybrid operations Elephant trunk (conventional Elephant trunk) + TEVAR. Brain was protected differently at each of the two stages of surgery. The best result was achieved at the second stage. According to the results of the study, the rate of post−surgery complications decreased from 34,4 to 8,4 %, hospital mortality reduced from 17,2 to 5,3 %, that allowed for certain indications to safely increase the volume of surgeries.

Key words: aorta, aortic arch aneurysm, aortic dissection, deep hypothermia, antegrade and retrograde cerebral perfusion.


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