Technology of "total" protection of the brain and internal organs under conditions of the "dry" aorta during aortic arch reconstruction.
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.
Department of Surgery of the Aorta and its Branches, RSCS, RAMS, Moscow, Russia.
Iu V
IuV
Belov
E R
ER
Charchian
D000328:Adult; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*