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Experience of surgical treatment of 111 patients with thoracoabdominal aorta aneurysm are presented in the article. All patients were operated in terms 2007 to December 2011 in the department of aortic surgery of acad. B.V. Petrovskogo RSCS of RAMS. All patients were divided into 3 groups. Thoracoabdominal aorta prosthetics from isthmus to bifurcation was performed in 10 patients of the first group. It was done descending thoracic aorta prosthetics in the second group (72 patients). The third group (29 patients) had suprarenal aorta prosthetics. The groups were comparable with respect to initial severity of underlying and concomitant diseases. Hemorrhage was 6242±3040, 2666±1590 and 2962±1547 ml respectively. Liver and renal failure developed in 10, 7 and 24% of cases respectively (p<0.05). Respiratory failure developed in 40, 33 and 27.6% of cases. Mortality was 10, 7 and 13.8% respectively. It was concluded about comparable treatment outcomes regardless of the amount of reconstruction. It is necessary to develop the techniques improving surgical treatment results and decreasing postoperative complications frequency.

We have analyzed clinical management of 137 patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease treated during last 10 years in the First Cardiac Surgery Department (Surgery of the Aorta and its Branches) of the Petrovsky National Research Center of Surgery. All patients were subjected to surgery involving both vascular regions: in 130 patients (94.9%) the procedures were staged while 7 patients underwent myocardial revascularization simultaneously with the reconstruction of the abdominal aorta from the minimal access. According to our results staged procedures are safer for patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease given the organism's limited capacity due to age and comorbidities. Endovascular repair techniques applied both to the coronary arteries and to the abdominal aorta should be always regarded primarily as a gentle form of intervention. In cases where open surgery is required one should try to avoid blood loss, reduce the duration of the procedure and use minimal access surgery when applicable. The overall mortality rate in patients treated for this disorder over the last 10 years was 2.1%.

It was investigated 30 patients after reconstructive ascending aorta and aortic arch surgeries. Neurocognitive testing was performed 2-3 days before surgery, through 24 hours and 10 days after surgery. Neurocognitive tests included Psychiatric Rating Scale, test "Information-Memory-Consideration Concentration", frontal dysfunction battery and test of clock drawing. Neuropsychological testing was performed by using of hospital scale of anxiety and depression evaluation and Covey scale. The observed moderate decrease of cognitive sphere in 24 hours after surgery has recovered by 10 days of postoperative period. Depressive disorders also were revealed in all stages of postoperative period. Inverse correlation between depressive and intellectual-mental disorders in examined patients was presented. It was suggested introduction of compulsory neurocognitive and psycho-emotional testing for improvement of surgical treatment results.

One of the most severe forms of multifocal atherosclerosis often accompanied by heart attacks and strokes is concomitant coronary and carotid artery disease. Unfortunately to date there have been no qualitative randomized trials allowing us to develop a unified optimal approach to the treatment of this pathology. We have analyzed the treatment of 128 patients with coronary artery disease and atherosclerotic carotid stenosis operated on the two vascular territories over the past 10 years in the Department of Surgery of the Aorta and its Branches of the Petrovsky National Research Center of Surgery. One-stage reconstruction in two arterial basins was performed on the majority (75%) of patients. Other patients underwent multistage procedures including the use of endovascular techniques. The absence of any significant differences in mortality and postoperative complications between groups subjected to single- and multi-stage treatment, doubtless reduction of risk of vascular complications in uncorrected arterial bed by one-stage reconstruction allows us to consider this treatment strategy the method of choice in the management of this pathology. Overall surgical mortality of patients with combined coronary and carotid artery involvement subjected to our strategy was 0.8%.

The Bentall-DeBono operation was proposed in 1968. It is the «gold standard" of the aneurysm treatment of the ascending aorta and aortic insufficiency nevertheless this technique is fraught with a number of possible postoperative complications. We have proposed an improved method: two short (10 mm) jaws and «skirt"« formed from the distal portion of the prosthesis were sewed to valved conduit. 19 operations were done by the proposed method in all. The control group included 73 patients who had operation according to the standard technique. Duration of extracorporeal circulation, myocardial ischemia, blood loss were the following: 145.4±54.4 and 117.4±40.9 min; 106.4±30.2 and 77.5±22.5 min; 473±355 and 1853±940 ml respectively. The mortality rate was 5.2% and 10.9% respectively. Our experience shows the technical simplicity of the procedure and satisfactory postoperative results.

It was done an evaluation of surgical treatment results of 71 patients with aortic arch aneurysm and aortic insufficiency, who were operated routinely. According to data of correlation and multiple regression analysis, chronic obstructive pulmonary disease and kidney disease before operation are significant factors predisposing to death in postoperative period. The authors consider that normalization of lungs and kidneys function before operation improves surgical treatment results in patients of this group.

It was done 163 operations on aortic arch in terms 2000 to December 2011. All patients were operated in the department of aortic surgery of acad. B.V. Petrovskogo RSCS of RAMS. 36 operations were performed by using of Borst's technique and 9 operations - by using of Kouchoukos technique in case of extended aneurysms of thoracic aorta. All patients did not differ in the severity of primary state, concomitant diseases and age. Duration of cardiopulmonary bypass and internal organs ischemia were 189±55/190±47 and 55±8/77±20 min respectively. Complication frequency was 27% and 22% in case of cardiovascular failure. Respiratory failure was 16.7% and 33%. Liver and renal failure was observed in 27% and 11% of cases. Encephalopathy was detected 33% and 22% of cases. Mortality was 22% and 11% of cases. It was concluded that Kouchoukos technique is alternative and safe method in thoracic aorta aneurysm treatment.

The issue centers on the critical analysis of the results of the aortic arch surgery, performed using the two basic methods: hemiarch and total arch replacement. 130 patients were included in the study. All were operated on in conditions of moderate hypothermia and antegrade brain perfusion. The study demonstrates that the volume of the intervention does not influence the results. The main success criteria is the adequacy of the brain and internal organs perfusion.

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.

Clinical cases of various intra- and postoperative gastrointestinal complications in cardiac and aortic surgery are discussed. Surgical tactics by such complications, as well as possible preventive measures are adduced.

To assess the risk of complications during the use of extracorporeal circulation at the stage of prosthetic reconstruction of the abdominal aorta in single-step interventions we carried out a systemic analysis of 20 publications mentioning the use of artificial circulation during aortic reconstruction, as well as analysed the works wherein aortic prosthetic repair was performed after artificial circulation was discontinued. The postoperative mortality rate in single-step interventions with the use of artificial circulation at the stage of aortic prosthetic reconstructions ranges from 0 to 25%, and that without artificial circulation varies from 0- 6.7%. A meta-analysis of the publications showed that the cumulative relative risk for development of complications is 3.14 times greater in those patients who at the stage of aortic reconstruction continued receiving artificial circulation. The use of artificial circulation does not decrease the incidence rate of myocardial infarction neither does it influence the rate of development of haemorrhage or purulent complications. However, the use of artificial circulation at the stage of prosthetic reconstruction of the abdominal aorta considerably increases the incidence rate of respiratory, renal and neurological complications. Hence, the advantages of using artificial circulation are levelled by high incidence of complications, while the opinion that the use of artificial circulation at the stage of prosthetic repair of the abdominal aorta decreases the incidence of myocardial infarction was not confirmed in our systemic review, therefore the use of extracorporeal circulation in single-step operations should be well-grounded.

Early postoperative complications and lethality after 166 operations on the thoracoabdominal aneurisms were analyzed. Overall frequency of the early complications was 31,9+/-3,6%, though some complications could cause the lethality of 88,9+/-10,5%. Thorough evaluation of pre- and intraoperative risk factors and individual patient-defined surgical tactics should lead to the decrease of early complications frequency.

Presented herein is own experience with aortic arch reconstructions performed in a total of twenty-two patients under conditions of antegrade cerebral perfusion. Of these, sixteen patients (Group One) were subjected to circulatory arrest in the lower part of the trunk, immediately followed by antegrade perfusion of the brain. The blood flow in the internal organs and the spinal cord was renewed only after completely forming the anastomosis with the aortic isthmus and the branches of the aortic arch. The technique we are suggesting here was employed in six patients (Group Two). After the beginning of antegrade cerebral perfusion, we inflated an intraaortic occluding balloon within the lumen of the descending aorta and commenced perfusion of the viscera through the femoral artery in order to continue perfusion in the internal organs. The duration of artificial circulation in Group One patients was significantly greater (P = 0. 0087), whereas the time of the aortic arch reconstruction was significantly longer in Group Two patients (P = 0.0045). Analysing the level of blood enzymes, lactate, and the renal function revealed significantly worse parameters in Group One patients, with a direct correlation being observed between the level of the onset of multiple organ failure and the duration of the aortic arch reconstruction (i. e., ischaemia of the internal organs and the spinal cord) in Group One patients, whereas no such correlation being noted in Group Two patients. Hence, the aortic branch reconstruction may be performed with the utmost protection of the brain and visceral organs by means of employing the above-described technique that has proved reliable and safe and turned out to yield excellent short-term outcomes.

Personality disorders (PD) are recognized among key maladaptive factors in postoperative period of coronary artery bypass surgery (CABS). However studies on PD among CABS patients are predominantly under psychological approach and information on clinical features is very limited. A present investigation aimed at assessing clinical features and prognostic value of PD in late post operative period of CABS (from 1 to 3 years). Using psychiatric, cardiological and psychological methods, 48 patients (42 male, mean age 61.3 +/- 8.2 years) with diagnosis of PD and favorable cardiological status after CABS have been assessed. PD in post operative period is an important predictor of unfavorable social and occupational outcome of CABS. Three types of clinical course of PD were singled out: 1) hypohondric personality development; 2) "second life" personality development; 3) "denial of illness" reactions. Pronounced maladaptation was observed in type 1, most severe one--in type 2 and minimal maladaptation or its absence--in type 3. These types were differentiated by different repertoires of psychological defense mechanisms (PMD): type 1 was characterized by a limited number of them with a drift to mature mechanisms; PD of type 2 are featured by a narrow and rigid repertoire of defenses with predomination of immature mechanisms and in type 3 a maximum number of PMD with balanced involvement of mature and immature mechanisms was observed.

In long-term period after resection of aorta coarctation, 9-14% patients developed aortic aneurysms, one third of them localized in the ascending aorta. From 146 patients operated on for aneurysm of the ascending aorta, 3 had aortic coarctation. In 2 patients aneurysms of the ascending aorta formed late after resection of the coarctation, the third patient was hospitalized with clinical picture of cardiac insufficiency at terminal stage due to coarctation of the aorta and a giant aneurysm of the ascending aorta with significant aortic insufficiency. The patients underwent successful surgeries: 1) ascending aorta grafting; 2) aortic valve and ascending aorta grafting by Bentallo de Bono method; 3) aortic valve and ascending aorta grafting by Bentallo de Bono method with bypass of descending aorta from the conduit. Cystic medianecrosis and two-volume aortic valve were revealed in all the patients. It is concluded that patients after surgery for coarctation of the aorta require long-term follow-up to defect cardiovascular complications early.

The trial included 894 patients in postoperative period with thrombosis of reconstructed arteries, who had undergone since 1975 1100 repeated reconstructive operations. Vast experience of reoperations on the vessels allowed to summarize various types of reoperations, to systematize them and to propose new classification. Surgical policy was determined by the causes of acute thrombosis and the time of its duration. Evaluation of the results of repeated reconstructions has revealed, that patency of the by-passes in the aorto-femoro-popliteal area in long-term postoperative period is significantly lower than after surgery on renal arteries and brachiocephalic branches. A significant difference in patency in femoro-popliteal and tibial segments is revealed since the 2nd year, in aorto-femoral-since the 4th year after surgery. The function of the shunts in patients with nonspecific aortic arteritis in follow up period is significantly lower than in patients with atherosclerosis beginning from the 2nd year of follow-up. The repeated reconstructive operations for early and late thromboses in femoro-tibial segment are almost ineffective. Up to year 3 after the repeated operation patients with stage II of ischemia after Fontaine make up 19%, and up to year 5--only 9%. In the rest of the patients chronic critical ischemia with the loss of the limb is develops.