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№3' 2021


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



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.


1. Coselli J. S., LeMaire S. A. Aortic arch surgery. Principles, strategies and outcomes. 1st ed. Wiley Blackwell. 2008. 400 p.

2. Improved clinical outcomes and survival following repaer of acute type A aortic dissection in the current era / B. D. Conway et al. // Interactive Cardiovascular and Thorac. Surg. 2014. Vol. 19 (6). P. 971−977. doi: 10.1093/icvts/ ivu268

3. Impact of retrograde cerebral perfusion of ascending aorta and arch aneurysm repair / H. J. Safi et al. // Ann. Thorac. Surg. 1997. Vol. 63 (6). P. 1601−1607. doi: 10.1016/s0003−4975(97)00296−8

4. Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: An analysis of more than 10,000 patients from the Japan Cardiovascular Surgery Database / Tomonobu Abe et al. // Eur. J. of Cardio−Thoracic Surgery. 2020. Vol. 57, Iss. 4. P. 660−667. doi:

5. Surgery for type A aortic dissection in patients with cerebral malperfusion: Results from the International Registry of Acute Aortic Dissections / Ibrahim Sultan et al. // J Thorac. Cardiovasc. Surg. 2019. № 14. doi:

6. Protection in aortic / Z. Qua Jason et al. // Arch. Surgery: An Evolving Field. 2020. № 21. doi:

7. Yutaka Okita. Current surgical results of acute type A aortic dissection in Japan // Annals of cardiothoracic surgery. 2016. Vol 5, № 4.

8. Outcomes after ascending aorta and proximal aortic arch repair using deep hypotermic circulatory arrest with retrograde cerebral perfusion analysis of 207 patients / K. Perreas et al. // Interactive Cardiovascular and Thorac. Surg. 2012. № 15 (3). R. 456−461. doi: 10.1093/icvts/ivs252

9. Surgical results of hemiarch repair for acute type A dissection / S. Ohtsubo et al. // Ann. Thorac. Surg. 2002. № 74 (5). R. 1853−1856. doi: 10.1016/s0003−4975(02)04133−4

10. Acute type A aortic dissection extending beyond ascending aorta limited or extensive distal repair / B. Rylski et al. // J. Thorac. Cardiovascular Surgery. 2014. Vol. 148 (3). P. 949−954. doi: 10.1016/j. jtcvs.2014.05.051.

11. Acute aortic dissection involving the root: operative and long−term outcome offer curative proximal repair / P. P. Urbanski et al. // Interactive Cardiovascular and Thorac. Surg. 2016. Vol. 22 (5). P. 620−626. doi: 10.1093/icvts/ivw002

12. Svensson L. G., Crawford C. C., Stanley E. Cardiovascular and vascular disease of the aorta. 1st ed. Saunders; 1997. 472 p.

13. Proximal aortic repair versus extensive aortic repair in the treatment of acute type A aortic dissection: a meta−analysis / Y. Yan et al. // Eur. J. Cardiothorac. Surg. 2016. Vol. 49 (5). P. 1392−1401. doi: 10.1093/ejcts/ezv351

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