Repeat surgical treatment of a patient with chronic type A aortic dissection an cerebral malperfusion syndrome

Boldyrev S.Yu.¹, Gunko I.I.², Abakumov N.I.¹, Alukhanyan O.A.², Barbukhatti K.O.², Porkhanov V.A.¹

1) Scientific Research Institute – Regional Clinical Hospital №1 named after Professor S.V. Ochapovsky under the Public Health Ministry of the Krasnodar Territory,
2) Department of Heart Surgery and Cardiology of the Faculty of Advanced Medical Training, Kuban State Medical University of the RF Public Health Ministry, Krasnodar, Russia

Described in the article is a clinical case report regarding repeat surgical intervention with prosthetic repair of the aortic arch and brachiocephalic arteries. The findings of computed tomography demonstrated residual proximal aortic dissection extending to the brachiocephalic trunk and the right common carotid artery. The patient was subjected to redo surgery consisting in aortic arch repair according to the fresh elephant trunk technique and reconstruction of the brachiocephalic arteries with a 24-mm multiple-branched graft Vascutek Gelweave Plexus 4 in conditions of extracorporeal circulation and circulatory arrest with antegrade bihemispheric cerebral perfusion. The postoperative period was complicated by reactive pneumonia. The patient was discharged on POD 30 in a satisfactory condition. Computed tomography at 6 months revealed nothing to be particularly noted.

This case report is suggestive of the necessity of working out a protocol of appropriate management of patients presenting with acute type A aortic dissection, which would make it possible to carry out treatment that would ensure no need for repeat interventions.

KEY WORDS: DeBakey type I aortic dissection, Stanford type A aortic dissection, redo surgery, aortic arch, cerebral malperfusion syndrome.

P. 170

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