Remote results of surgical reconstruction of the aortic arch in patients with proximal aortic dissection

Alsov S.A., Chernyavsky A.M., Lyashenko M.M., Sirota D. A., Khvan D.S., Vinogradova T.E., Lomivorotov V.V.

Centre for Surgery of the Aorta, Coronary and Peripheral Arteries, Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin, Novosibirsk, Russia

Introduction. It is generally known that Stanford type A aortic dissection has up to now been a serious problem of cardiothoracic surgery. The current state of the art of aortic surgery, anaesthesiological support, and perfusion strategy make it possible to achieve acceptable results in the early postoperative period in various-difficulty aortic arch reconstruction. Taking into consideration that the pathological process to some extent involves the brachiocephalic arteries, of special interest are remote results of various in aggressiveness and radicality types of reconstruction of the aortic arch in its proximal dissection from the point of view of the development of delayed impairments of cerebral circulation.

Materials and methods. Over the period from 1999 to 2011, specialists of the Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the Ministry of Public Health and Social Development operated on a total of 124 patients presenting with DeBakey type I aortic dissection.

All factors supposedly influencing the development of cerebral ischaemia were subdivided into the qualitative and quantitative ones. The qualitative factors included gender, aetiology, type of dissection, type of aortic arch reconstruction, type of cerebral perfusion, type of intervention on the aortic root, previous operations on the heart, and the presence of accompanying CAD, arterial hypertension, chronic obstructive pulmonary diseases, and renal pathology. The quantitative factors were as follows: age, height, body weight, duration of assisted circulation (AC), duration of aortic occlusion (AO), duration of circulatory arrest (CA). We examined a total of 80 patients within the terms of 11-124 months (mean 48.3±26.0 months) after surgical treatment. We studied interrelationship between the factors and the development of cerebral circulation impairments in the remote postoperative period.

Conclusions. In the remote postoperative period virtually all cases of focal impairments of cerebral circulation were associated with accompanying atherosclerosis, i.e. the already compromised brachiocephalic vascular bed. Amongst the qualitative parameters the most significant variables were: aetiology, accompanying diseases, and the type of cerebral perfusion.

KEY WORDS: aortic dissection, aortic arch.

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