[Problems of brain protection in aortic arch operations].

33 patients (25 men and 8 women, aged 18 to 69 years, mean age 47 +/- 12.3 years), underwent ascending aorta and aortic arch replacement. During arch replacement the authors used the following brain protection methods: profound hypothermic circulatory arrest--in 4 (12.1%) patients, retrograde brain perfusion via superior vena cava--in 11 (33.3%), antegrade perfusion via brachycephalic vessels--in 18 (54.6%) patients. Pharmacological brain protection was applied in all cases as an addition to the listed techniques. 14 (45%) patients underwent partial aortic arch replacement; in 19 (57.6%) patients total aortic arch replacement was performed, including "elephant trunk" distal anastomosis in 4 cases. Hospital mortality rate in patients who underwent operations on the aortic arch was 18.1% (6 patients). Postoperative neurological disorders, such as transient dysfunction, were observed in 8 (24%) patients; cerebral strokes or intractable neurological disorders were not recorded. The choice of a brain protection method is determined by the extent of the operation and necessary circulation arrest time.

[Spiral computed tomography in aortic aneurysm diagnostics].

10-year experience of use of spiral computed tomography (CT) with bolus intravascular contrasting allowed the authors to determine the advantages of this method in aortic aneurysm diagnostics and to show the importance of its application in dynamic monitoring. The article also covers drawbacks of the method, which are not so significant as the advantages, because the CT method answers practically all surgeon's questions, including the length, localization of aneurism, presence of congenital vascular anomalies, fistulas, hemorrhages or prosthesis infection in postoperative period. CT meets all the diagnostic requirements and bears minimal risk while quickly giving enough information about anomalies of bloodstream and surrounding tissues in a certain patient.

[Personality disorders in postoperative period of coronary artery bypass graft surgery]. / Rasstroistva lichnosti v posleoperatsionnom periode aortokoronarnogo shuntirovaniia.

Personality disorders (PD) are recognized among key maladaptive factors in postoperative period of coronary artery bypass surgery (CABS). However studies on PD among CABS patients are predominantly under psychological approach and information on clinical features is very limited. A present investigation aimed at assessing clinical features and prognostic value of PD in late post operative period of CABS (from 1 to 3 years). Using psychiatric, cardiological and psychological methods, 48 patients (42 male, mean age 61.3 +/- 8.2 years) with diagnosis of PD and favorable cardiological status after CABS have been assessed. PD in post operative period is an important predictor of unfavorable social and occupational outcome of CABS. Three types of clinical course of PD were singled out: 1) hypohondric personality development; 2) "second life" personality development; 3) "denial of illness" reactions. Pronounced maladaptation was observed in type 1, most severe one--in type 2 and minimal maladaptation or its absence--in type 3. These types were differentiated by different repertoires of psychological defense mechanisms (PMD): type 1 was characterized by a limited number of them with a drift to mature mechanisms; PD of type 2 are featured by a narrow and rigid repertoire of defenses with predomination of immature mechanisms and in type 3 a maximum number of PMD with balanced involvement of mature and immature mechanisms was observed.

Eight years clinical experience with the replacement of the ascending aorta using composite xenopericardial conduit.

OBJECTIVE: The evaluation of early and late results after ascending aorta replacement with composite glutaraldehyde-treated xenopericardial valved conduit. METHODS: From December 1989 to May 1999 the ascending aorta was replaced with 148 composite xenopericardial conduits aorta in 145 patients. Biological valves were inserted in 28 conduits, mechanical valves - in 116. The age of 40 female (28%) and 105 male (72%) patients ranged from 10 to 60 years (mean, 38.7+/-12 years). The original diseases were: atherosclerosis in 51 (35%), cystic media necrosis in 50 (35%), Marfan syndrome in 35 (24%), syphilis in three (2%), non-specific aortitis in one (0.7%), Turner syndrome in one and infective endocarditis in four cases. Aortic dissection was found in 67 patients (46%): type I in 14 (23%) and type II in 53 (77%). Twenty-one patients (15%) were operated on during the acute phase of the dissection. The Bentall-DeBono technique was used in 144 operations, in four cases (2.7%) supracoronary resection was performed. Associated procedures included: mitral valve repair (five), CABG (four), resection of the coarctation (two), MV replacement (two). Biological tissues condition was assessed using TTE TEE and computed tomography (CT) scanning technique. RESULTS: Hospital mortality was 8.3 % (12 patients). The death was caused by: low cardiac output (three), arrhythmia (two), neurological complications (one), sepsis (one), polyorgan failure (four), bleeding (one). Non-lethal complications included: bleeding (four), heart failure (two), persisting A-V block (two), polyorgan failure (three), cerebral (two), mediastinitis (three), and early prosthetic endocarditis in three patients. All three patients with endocarditis were successfully re-operated and conduit replaced with the same type of the device. Late follow-up ranged from 2 months to 8 years (mean, 51 months) and complete in 87% of the discharged patients (115 patients). There were four valve-related deaths due to thrombembolia and five deaths non related to the valve and/or conduit. Clinical and instrumental evaluation did not reveal any signs of tissue degeneration at the conduit and biovalves' cusps. CONCLUSIONS: The xenopericardial valved conduit is an effective and acceptable device for the replacement of ascending aorta in almost all cases, it provides good early and late results. It's pliability and elasticity are especially attractive in situations with frail tissues and high risk of bleeding.

[Clinical applications of xenopericardial conduits in surgery of ascending aortic aneurysms]. / Klinicheskoe primenenie kscenoperikardial'nykh konduitov v khirurgii anevrizm voskhodiashchei aorty.

At the Department of Acquired Cardiac Diseases (Head is Prof. G. I. Tsukerman), A. N. Bakulev Institute of Cardiovascular Surgery, 145 patients underwent operation for ascending aortic aneurysms, out of them the Bentalle-De Bono and the Cabrol operations were performed in 81 and 25 patients, respectively, the remaining 39 patients had palliative interventions. From February 1991 to April 1993, the clinic performed in 11 patients prosthesis of the ascending aorta with a xeno-pericardial conduit containing a bioprosthesis of the same tissue. The paper describes the technical features of bio-conduit implantation. The use of xeno-pericardial conduits facilitates the technique of applying anastomoses, lowers hemophilia and reduces the length of an operation. Hemorrhagic and thromboembolic events are expected to be reduced in late periods. At the hospital stage 1 patient died. The cause of his death was peri-coronary hematoma. Ten patients are still under observation. Repeated examinations have not detected no specific complications typical of those observed in the application of synthetic conduits. The first experience has proved to be quite promising. However, the final assessment is possible only when sufficient clinical materials are accumulated and late outcomes are studied.

[Reoperations after insertion of heart valve prosthesis]. / Povtornye operatsii posle protezirovaniia klapanov serdtsa.

The authors analysed 167 repeated operations after heart valve prosthetics, which were conducted from 1978 to 1988. The operations were undertaken for the second time mainly in a severe contingent of patients. The reasons for the repeated operations were specific complications according to which 2 groups of patients were set apart: with dysfunction of the prosthesis of noninfectious origin and with prosthetic endocarditis. Study showed that repeated operative intervention undertaken in time reduces considerably its risk and produces a stable positive effect in most cases.

[Unsolved problems of the surgical treatment of dissecting aneurysms of the ascending aorta (analysis of complications)]. / Nereshennye voprosy khirurgicheskogo lecheniia rasslaivaiushchikh anevrizm voskhodiashchei aorty (analiz oslozhnennii).

It is shown that various complications occurring after surgical treatment of dissecting aneurysms of the ascending aorta with or without aortic insufficiency depend mainly on the methods of correction applied and the etiology of the disease. As the result of the study the authors conclude that the Bentall-De Bono and Cabroe's operations are radical methods for surgical management of dissecting aneurysms of the ascending aorta irrespective of the etiology of the disease. Wide introduction of these operative methods into the clinical practice led to an essential decrease of hospital mortality and the frequency of complications in the immediate and late-term postoperative period.

[Surgical treatment of endocarditis following heart valve prosthesis]. / Khirurgicheskoe lechenie proteznogo éndokardita.

Experience of many years in surgical treatment of prosthetic valve endocarditis (RVE) is analyzed. Patients whose condition was serious were operated on for a second time: 91.6% had preoperative functional class IV, in half of them circulatory disorders were of stage IIB--III; 62.4% were subjected to reoperation for emergency indications. Twenty-five reoperations were performed for early PVE with 52% hospital mortality, 23 reoperations-for late term PVE with mortality of 30.4%. The most frequent cause of PVE was staphylococcal infection which showed a tendency to increase in the recent years. In early PVE the severity of the condition in the recent years. In early PVE the severity of the condition was due to sepsis and intoxication, in late-term PVE it was caused by disorders of hemodynamics which were usually induced by dysfunction of the prosthesis. The results of surgical management of PVE depended on the severity of the patient's condition before the operation, timely performance of the operation, and the efficacy of antibacterial therapy.

[Choice of the correction method and results of surgery in patients with mitral, aortic and tricuspid defects of the heart]. / Vybor metoda korrektsii i rezul'taty operatsii u bol'nykh s mitral'no-aortal'no-trikuspidal'nymi porokami serdtsa.

The article analyses the results of surgical correction of tri-valvular heart diseases in 132 patients who were operated on between January, 1973 and March, 1986. Total hospital mortality was 20.4%. Among the last 72 operations conducted from January, 1980 hospital mortality amounted to 14.0% (10 patients died). The results of the operations were approximately the same in the different methods of correction: 105 patients were studied in late follow-up periods (from 6 months to 14 years). With consideration for the hospital losses, by the 7th year of follow-up the survival after prosthetic replacement of 3 valves was 61.8%, after replacement of the mitral and aortic and valvuloplasty of the tricuspid valve--60.6 degrees. The stability of good results was 59.6 and 58.1%, respectively. Among and analogous group of patients who received drug treatment survival by the 7th year was 28.1%, which is evidence of the obvious advantages of the surgical method of treatment. The results were best in patients subjected to plastic operations on two and three valves.

[Surgical tactics in dissecting aneurysms of the ascending aorta]. / Khirurgicheskaia taktika pri rasslaivaiushchikh anevrizmakh voskhodiashchei aorty.

The aspects of surgical tactics in management of dissecting aneurysms of the ascending aorta are analysed in relation to the disease etiology, the anatomical pattern of the aortic root, presence of attending aortic insufficiency, and dissection extension. Based on the experience of 32 operations (March 1979--February 1988), it is concluded that the abnormal type must be the best criterion for choosing the surgical technique. In dissecting aneurysms due to aortic wall degeneration, Bentall-De Bono and Cabrol's modifications are preferable. In dissecting aneurysms of atherosclerotic origin, the boundary of the proximal extension of dissection should be taken into account. When the dissection extends into the aortic root, the operation using a valve-containing conduit with reimplantation of the ostia of the coronary arteries is feasible. If the aortic root is not involved, isolated prosthesis of the ascending aorta or separate prosthesis of the aortic valve and ascending aorta may be performed depending on the presence of aortic failure.

Surgical treatment of dissecting aneurysm of the ascending aorta: immediate and late results.

The authors describe experience gained with surgical treatment of dissecting aneurysm of the ascending aorta in the period from 1978 to 1987. 30 patients were operated on using the techniques proposed by Bentall, De Bono and Carbrol. All patients exhibited the presence of annulo-aortic ectasia. Hospital mortality in the past four years was 20%. On the basis of an analysis of immediate and late results the authors come to the conclusion that Bentall's, De Bono's and Cabrol's technique is the method of choice for surgical corrections of annulo-aortic ectasia and Marfan's syndrome.

[Long-term results of the surgical treatment of aneurysm of the ascending aorta in combination with aortic valve insufficiency]. / Otdalennye rezul'taty khirurgicheskogo lecheniia anevrizm voskhodiashchego otdela aorty s sochetanii s nedostatochnost'iu aortal'nogo klapana.

Four of 28 patients who were operated on died in late-term periods, four from advancing cardiac failure and one died 5 years after an operation from cardiac tamponade. In the group of four patients one underwent Cabrol's operation, three were operated on by the Bentall-De Bono method. The condition of 25 patients considerably improved and they were related to the II and I functional classes. The result was poor in three patients due to initial severity of the process in one, dilatation of the arch of the aorta in another, the presence of a fistula in the distal anastomosis in the third. One patient treated by Cabrol's operation and another who was operated on by the Bentall-De Bono method had pseudoaneurysms in the orifices of the coronary arteries. Despite some complications which occurred in the late postoperative periods, the Cabrol and Bentall-De Bono operations are the most radical means today for surgical treatment of aneurysms of the ascending aorta.

[Surgical treatment of aneurysm of the ascending aorta in Marfan syndrome]. / Khirurgicheskoe lechenie anevrizmy voskhodiashchei aorty pri sindrome Marfana.

An experience with 26 operations for aneurysms of the ascending aorta with a concomitant insufficiency of the aorta valve in Marfan syndrome is described. We started using operations after Bentall-De Bono in 1979 and operations after Cabrol in 1983 which were used in cases with low localization of openings of the coronary arteries in relation to the fibrous ring of the aorta valve, as well as in cases with the dissecting aorta wall, especially involving the area of the openings. These operations allowed the intrahospital lethality to be reduced: in the period of 1979-86 it made up 30% (6 patients died out of 20), in 1983-86 it was 15.4%, in 1986 it was 12.5%.

[Immediate results of the surgical treatment of aneurysms of the ascending aorta associated with aortic insufficiency]. / Neposredstvennye rezul'taty khirurgicheskogo lecheniia anevrizm voskhodiaschei aorty s soputstvuiushchei aortal'noi nedostatochnost'iu.

Experience with surgical treatment of ascending-artery aneurysms with concomitant aortic insufficiency is summed up. Forty-four patients were operated on, 30 of those having dissecting aneurysm of the ascending aorta. There were 6 operations where coronary arterial openings were isolated and stitched into a valve-containing conduit and 8 supracoronary resections with prosthetic aortic valve implantation. Hospital mortality rate was 78.6%. Thirty patients underwent Bentall-De Bono operation or Cabrol's operation. Hospital mortality was 26.6%. As surgical techniques and corrective methods improved, hospital mortality could be considerably reduced (to 7.7%).