Search

Introduction: It is generally known that Stanford type A aortic dissection has up to now been a serious problem of cardiothoracic surgery. The current state of the art of aortic surgery, anaesthesiological support, and perfusion strategy make it possible to achieve acceptable results in the early postoperative period in various-difficulty aortic arch reconstruction. Taking into consideration that the pathological process to some extent involves the brachiocephalic arteries, of special interest are remote results of various in aggressiveness and radicality types of reconstruction of the aortic arch in its proximal dissection from the point of view of the development of delayed impairments of cerebral circulation., Material and Methods: Over the period from 1999 to 2011, specialists of the Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the Ministry of Public Health and Social Development operated on a total of 124 patients presenting with DeBakey type I aortic dissection. All factors supposedly influencing the development of cerebral ischaemia were subdivided into the qualitative and quantitative ones. The qualitative factors included gender, aetiology, type of dissection, type of aortic arch reconstruction, type of cerebral perfusion, type of intervention on the aortic root, previous operations on the heart, and the presence of accompanying CAD, arterial hypertension, chronic obstructive pulmonary diseases, and renal pathology. The quantitative factors were as follows: age, height, body weight, duration of assisted circulation (AC), duration of aortic occlusion (AO), duration of circulatory arrest (CA). We examined a total of 80 patients within the terms of 11-124 months (mean 48,3±26,0 months) after surgical treatment. We studied interrelationship between the factors and the development of cerebral circulation impairments in the remote postoperative period., Conclusion: In the remote postoperative period virtually all cases of focal impairments of cerebral circulation were associated with accompanying atherosclerosis, i. e. the already compromised brachiocephalic vascular bed. Amongst the qualitative parameters the most significant variables were: aetiology, accompanying diseases, and the type of cerebral perfusion.

Due to considerable incidence of combined cardiac and vascular pathology in elderly and aged patients with heart valve defects, of special importance is the problem regarding surgical therapeutic decision-making. The present article is aimed at considering the problems concerning possibility and feasibility of stagewise or simultaneous surgical correction in patients diagnosed as having cardiac valve defect and haemodynamically significant lesions of coronary and/or brachiocephalic arteries based on generalizing the results of international studies.

Described in the article is a clinical case report concerning single-step surgical management of a male patient presenting with multifocal atherosclerosis accompanied by an aneurysm of the ascending aorta and proximal segment of the aortic arch combined with lesions of the coronary and brachiocephalic vessels, thus showing a possibility of surgical treatment in this cohort of patients, if completely and timely diagnosed. Performing a one-stage operation without aggravating the surgical intervention makes it possible to decrease the risk of complications of both the heart and brain in the intra- and postoperative periods.

Annually, about 400,000 new patients with strokes are recorded in Russia. Of these, 80% of patients may develop ischemic brain infarctions. In approximately 30-40% of cases, ischemic lesion of the brain eventuates in lethal outcome; the same number of patients remain heavily disabled and only 15-20% of patients return to the previous level of work fitness. In 30-50% of cases, the development of ischemic stroke and other forms of cerebrovascular insufficiency is caused by stenotic and occlusive lesion of aortic arch branches, being more frequently of atherosclerotic origin. Patients with brachiocephalic artery (BCA) lesion face an important problem of the origin and progression of different forms of cardiac rhythm disorders. In the presence of hemodynamically significant stenotic and occlusive lesion of brain vessels, even transient changes in cardiac rhythm may induce an additional deterioration of cerebral flow. In turn, the origin of arrhythmias in the immediate postoperative period in patients after reconstructions on the BCA is a serious complication which may lead to sudden death. The aim of the present study was to examine the long-term results of the surgical treatment in patients with associated BCA lesion and paroxysmal disorders of cardiac rhythm (PDCR). The treatment results were analyzed in 89 patients aged 35 to 70 years. There were 66 (74.2%) men and 23 (25.8%) women. All the patients had undergone different BCA reconstructions. In the long-term period, this resulted in the lowering of the death rate. Besides, in the long-term period, vascular reconstructions carried out in patients with associated BCA lesion and PDCR not only improved the neurologic status but also favoured the positive course of changes in arrhythmias in 36.4% of patients.