[Problems of brain protection in aortic arch operations].
33 patients (25 men and 8 women, aged 18 to 69 years, mean age 47 +/- 12.3 years), underwent ascending aorta and aortic arch replacement. During arch replacement the authors used the following brain protection methods: profound hypothermic circulatory arrest--in 4 (12.1%) patients, retrograde brain perfusion via superior vena cava--in 11 (33.3%), antegrade perfusion via brachycephalic vessels--in 18 (54.6%) patients. Pharmacological brain protection was applied in all cases as an addition to the listed techniques. 14 (45%) patients underwent partial aortic arch replacement; in 19 (57.6%) patients total aortic arch replacement was performed, including "elephant trunk" distal anastomosis in 4 cases. Hospital mortality rate in patients who underwent operations on the aortic arch was 18.1% (6 patients). Postoperative neurological disorders, such as transient dysfunction, were observed in 8 (24%) patients; cerebral strokes or intractable neurological disorders were not recorded. The choice of a brain protection method is determined by the extent of the operation and necessary circulation arrest time.
Malashenkov
A I
AI
Rusanov
N I
NI
Bykova
V A
VA
Rychin
S V
SV
Aĭteliev
A E
AE
Iakovlev
S E
SE
Imaev
T E
TE
D000293:Adolescent; D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000009:adverse effects*