[Djumbodis stent migration in a patient with aortic dissection]. / Migratsiia stenta Djumbodis u bol'nogo s rassloeniem aorty.

Treatment of patients presenting with type I aortic dissection is known to be a surgical challenge. The Djumbodis bare metal stent was developed to ease the burden of a reconstructive intervention on the aortic arch, to decrease the duration of the operation, and to minimize complications associated with artificial circulation. Currently, insufficiently explored remains the problem of complications occurring due to the technological fatigue of the metal and possible stent migration. Described herein is a clinical case report regarding migration of a Djumbodis stent, diagnosed 6 months after implantation for DeBakey type I acute aortic dissection. We revealed dislocation of the stent's distal portion with fenestration of the membrane of the true channel and perfusion of the false channel, as well as fractured fragments of the stent. The patient underwent repeat 'open' intervention.

[Microsurgery of coronary arteries using an operating microscope]. / Mikrokhirurgiia koronarnykh arterii s ispol'zovaniem operatsionnogo mikroskopa.

The world experience of coronary artery bypass surgery using an operating microscope is reviewed in the article. Important role of operating microscope and microsurgical techniques for coronary anastomoses formation is shown. High optical magnification provided by operating microscope directly affects the quality of surgical technique and accuracy of coronary anastomoses suturing that affects postoperative graft patency. Thus, the use of operating microscope can affect the results of coronary artery bypass surgery, as shown in several reports.

[Use of uncoated metal stents in surgery of aortic dissection]. / Primenenie nepokrytykh metallicheskikh stentov v khirurgii rassloeniia aorty.

Presented herein is a review of the literature concerning the use of uncoated metal stents in surgery of aortic dissection. A conclusion was drawn that the results of using the Djumbodis stent should not be directly extrapolated to the outcomes obtained in case of the E-XL stent which had mainly been used for hermetic sealing and for creation of optimal conditions for TEVAR. It is pointed out that the use of uncoated metal stents in aortic surgery is acceptable, however, it is required to solve a series of problems associated with elimination of certain shortcomings of the available devices. Also, it is necessary to work out clear-cut indications for using these stents.

[Predictors of neurological complications during surgical treatment of the ascending aorta and aortic arch chronic dissection]. / Prediktory nevrologicheskikh oslozhnenii pri khirurgicheskoi korrektsii khronicheskogo rassloeniia voskhodiashchego otdela i dugi aorty.

AIM: To evaluate the prognostic significance of oxygen supply to the brain in the risk of neurological complications in the early post operative period of surgical treatment of the ascending aorta and aortic arch. MATERIAL AND METHODS: The level of oxygenation (rSO2) in the right and left hemispheres was measured in 68 patients with ascending aorta and aortic arch chronic dissection. Before and in the nearest period after surgery, the patients underwent a clinical/instrumental neurological study. RESULTS: The incidence of ischemic stroke in the early post operative period was 5.9%, cognitive impairment was recorded in 22% of patients. Among the parameters of oxygen supply to the brain, the dynamics of rSO2 during circulatory arrest had a significant impact on the post operative neurological status. The risk of cognitive impairment, besides the association with the oxygen status of the brain, increased with the age of patients and comorbid pathology. CONCLUSION: The decrease in rSO2 by ≥30% during surgical treatment of ascending aorta and aortic arch dissection increases the risk of ischemic stroke and cognitive impairment in the early post operative period.

[A case of treating a patient with a false aneurysm of the xenoconduit of the ascending aorta and pronounced cardiac insufficiency].

Described in the article is a clinical case of treating a previously operated patient presenting with a pseudoaneurysm of the xenoconduit of the ascending aortic portion, functioning Cabrol fistula and pronounced cardiac insufficiency, who was admitted to our institution in the state of decompensation. The obtained outcomes of treating this patient demonstrated a possibility of successfully using vascular grafts for establishing an anastomosis between the left coronary artery and ascending portion of the aorta in complicated conditions of a repeat intervention.

[Application of multiple-branch prostheses in reconstruction of the aortic arch in DeBakey Type I aortic dissection].

Over the period from January 2002 to March 2005, a total of 78 patients were operated on for DeBakey type I aortic dissection. Of these, five patients underwent prosthetic reconstruction of the aortic arch and brachiocephalic arteries (BCA), performed with the help of the Dacron prosthesis Gelweave four-branch plexus Vascutek. The major indication for using this prosthesis was the extending of the dissection into the BC As, with various degree of obstruction thereof. The overwhelming majority of the patients were men (80 %). The patients' average age amounted to 44.3+/-5.6 years (ranging from 36 to 57 years). In three cases, the aortic dissection was of chronic course, with acute and subacute dissection being diagnosed in the remaining two cases. The median-sternotomy access, and additional approaches to the left and right common carotid arteries were used in order to carry out prosthetic reconstruction of the ascending branch, aortic arch, right subclavian artery, right common carotid artery (CCA) and left CCA with the help of the multiple-branch prosthesis. Protection of the brain consisted of craniocerebral hypothermia, hypothermal circulatory arrest in a combination with retrograde cerebral perfusions through the vena cava superior. The duration of the circulatory arrest averagely amounted to 59.2+/-4 min, with the mean time of artificial circulation equalling 230.6+/-19.7 min, and the time of aortic occlusion was 193.1+/-11 minutes. None of the patients developed either neurological or haemorrhagic complications postoperatively. Hence, the surgical technique using multiple-branch prostheses for prosthetic reconstruction of the aortic arch in type I aortic dissection with BCA obstruction proved to be effective and safe.

The choice of the technique for harvesting and preparation of the radial artery for coronary artery bypass grafting.

At present coronary artery disease (CAD) is a most frequently occurring cause of the lethality and disability of patients. One of the basic methods for CAD treatment is coronary artery bypass grafting (CABG). Actuality of the problem of applying the radial artery (RA) for CABG is determined by the proven advantage of arterial grafts versus vein grafts in myocardial revascularization. Today the RA ranks second in frequency of using the arterial graft subsequently to the internal thoracic artery (ITA). The RA may be harvested by two techniques: skeletization and in a case with surrounding tissue. However, to this day there is no unanimous opinion as regards the advantages of one or another approach. Of importance is conduit conservation from the time of harvesting to implantation into the coronary artery position. Despite a great number of conservants offered for conservation before implantation, comparative analysis of their effect on the conduit endothelium was not carried out. The problem of the safety of the RA conduit also remains open to discussion.

Left ventricular dimension and shape after postinfarction aneurysm repair.

OBJECTIVE: We evaluated left ventricular dimensions and shape in the patients with postinfarction LV aneurysm before and after different techniques of ventricular reconstruction. METHODS: From January 1997 to December 2003, 158 patients underwent LV aneurysm repair. There were 152 men and 6 women, with a mean age 50+/-8.4 years. Ventricular reconstruction was performed by using linear plasty of the Cooley technique in 35 patients, septal plasty of the Stoney technique-in 57 patients, and endoventriculoplasty of the Dor technique-in 66 patients. Left ventricular volumes and dimensions, global and contractile left ventricular function, diastolic sphericity were analyzed before and after operation over a period of 10 days to 5 years. RESULTS: The EchoCG studies showed a significant postoperative improvement of the LV contracting function regardless of LV plasty technique used. The index of sphericity changed from 0.71+/-0.08 to 0.72+/-0.06 after linear plasty, from 0.71+/-0.05 to 0.73+/-0.07 after septal plasty, from 0.74+/-0.06 to 0.56+/-0.05 after endoventriculoplasty. The hospital mortality rate was 6.3%. There is no significant difference in hospital mortality rates between the different techniques of LV aneurysm repair. CONCLUSIONS: Our results show the effectiveness of different techniques of LV aneurysm repair, when the differentional approach to choice an adequate method of ventricular reconstruction was applied.