<p><strong>Aim:</strong> The study was designed to evaluate the outcomes of aortic valve reimplantation (David procedure), as well as various techniques of aortic root reconstruction.<br /><strong>Methods:</strong> The results of 84 valve-sparing operations for thoracic aortic aneurysms and dissections were analyzed at B. Petrovsky Russian Research Center of Surgery over a period from 2007 to 2016. The first group (n = 42) consisted of patients after David procedure, the second group (n = 38) included patients after different methods of aortic root repair (fixation of commissures, leaflets plication, sinotubular ridge repair). 5-year results of surgical treatment were assessed.<br /><strong>Results:</strong> David procedure is characterized by good long-term results. There was no in-hospital and 5-year mortality in the first group, while 2 (5.3%) patients in the second group died in the early postoperative period. In both groups the reoperation rate was 2.4% and 8.3% respectively.<br /><strong>Conclusion:</strong> Valve-sparing aortic root repair is characterized by good survival rate, high freedom from reoperation and low incidence of complications.</p>

<p><strong>Aim.</strong> The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. <br /><strong>Methods.</strong> The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. <br /><strong>Results.</strong> In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range.<br /><strong>Conclusion.</strong> The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.</p><p>Received 21 June 2016. Accepted 21 October 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A.<br />Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V.<br />Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A.<br />Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. <br />Review &amp; editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.</p>

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Objective: to carried out the comparison of the data of MDCT of the patients, undergoing screening using the standard protocol MDCT aortography and FLASH “fast” protocol of scanning. It is discussed the possibility of the reduction of the injected amount of the contrast agent for “fast” aortography.Materials and methods. The aorta examinations of 101 patients (69 men (68%) and 32 women (32%); the average age ± the standard deviation – 56.34 ± 11.5 years) were analyzed. The examinations have been carried out on MDCT with two sources of Х-ray (DSCT); 48 patients have been undergone the examination using “fast” FLASH scanning. It has been compared the scanning time, the length of the examination zone and ED (Effective Dose) load calculated for the groups for the standard and “fast” MDCT aortography.Results. CDTIvol and DLP values were statistically proved lower (p < 0.001) at the examination of the patients that had been undergone “fast” protocol of scanning FLASH. The average ED was considerably lower in this group of the patients in comparison with the patients that had been examined using standard protocol (4.36 ± 1.69 mSv and 15.12 ± 4.62 mSv, р < 0.001). Without the reliable difference in the length of the examination zone in groups (42.91 ± 3.23 cm and 43.68 ± 2.66 cm, p = 0.55), the duration of the examination of MDCT aorta was considerably lower in the second group (9.29 ± 0.85s and 1.93 ± 0.12 s, p < 0.001). Conclusion. The method of the superfast aorta МDCT make it possible to reduce ED and the amount of the injected contrast agent at the examination of the vast zone. At the same time, qualitative and quantitative analysis of the MDCT remains high.

The objective: to compare the effectiveness of visceral and renal protection methods during thoracoabdominal aortic (TAA) repair: left atrial-femoral bypass (LAFB) and cardiopulmonary bypass (CPB) in conjunction with selective perfusion (SP) of these organs.Subjects: 81 patients who underwent TAA repair were enrolled in retrospective analysis: LAFB was used in 29 patients (Group 1), CPB and SP ‒ in 52 patients (Group 2).Results. In Group 2, there were lower intraoperative blood loss volume (1,500 ml vs 4,200 ml, p < 0.001), significantly lower levels of direct bilirubin, blood creatinine, blood alpha-amylase in postoperative period, significantly shorter duration of hospital stay, ICU stay and duration of mechanical ventilation. Also in this group, there were lower incidence of multiple organ dysfunction (11.5% vs 37.9%, p = 0.005), stroke (0 vs 10.3%, p = 0.043), lower need for requirement (3.8% vs 20.7%, p = 0.022) and mortality (3.8% vs 27.6%, p = 0.003).Conclusion: During TAA repair, CPB in conjunction with selective visceral and renal perfusion is more beneficial for organ protection as compared with LAFB.