METHODS TO PROTECT THE SPINAL CORD AND VISCERAL ORGANS IN SURGERY OF DISTAL AORTIC DISSECTIONS

Belov Yu.V., Komarov R.N., Stepanenko A.B., Gens A.P., Charchyan E.R.
Department of Surgery of the Aorta and its Branches under the Russian Scientific Centre of Surgery named after B.V. Petrovsky, Russian Academy of Medical Sciences,
Moscow, Russia

The problem of protecting the spinal cord and visceral organs in surgery of distal aortic dissections becomes increasingly important today because of a comparatively high incidence rate of complications. Paraparesis in type 3 dissecting aortic aneurysm (DAA) is noted to occur in ischaemia of the spinal cord lasting more than 56.5±12 min and the inclusion into the blood flow of less than two responsible intercostal arteries. Multipleorgan insufficiency in type 3 DAA is observed in ischaemia of the visceral organs lasting more than 36.4±6.9 min. While using profound hypothermia and circulatory arrest, fatal haemorrhage appears when the duration of the hypothermic arrest is more than 48±13.5 min.

The used methods aimed at protecting the spinal cord and visceral organs (perfusionfree technique with cerebrospinal fluid drainage, left artiofemoral bypass, circulation arrest with deep hypothermia), optimization of the scope and technique of the operation, shortened duration of ischaemia, inclusion of the maximum number of the spinal arteries into the blood flow, the use of the system of collection and return of blood make it possible to expect a decreased number of complications.

KEY WORDS: type B dissecting aortic aneurysm, protection of the spinal cord and visceral organs.

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