<p><strong>Aim:</strong> The study was designed to evaluate the outcomes of aortic valve reimplantation (David procedure), as well as various techniques of aortic root reconstruction.<br /><strong>Methods:</strong> The results of 84 valve-sparing operations for thoracic aortic aneurysms and dissections were analyzed at B. Petrovsky Russian Research Center of Surgery over a period from 2007 to 2016. The first group (n = 42) consisted of patients after David procedure, the second group (n = 38) included patients after different methods of aortic root repair (fixation of commissures, leaflets plication, sinotubular ridge repair). 5-year results of surgical treatment were assessed.<br /><strong>Results:</strong> David procedure is characterized by good long-term results. There was no in-hospital and 5-year mortality in the first group, while 2 (5.3%) patients in the second group died in the early postoperative period. In both groups the reoperation rate was 2.4% and 8.3% respectively.<br /><strong>Conclusion:</strong> Valve-sparing aortic root repair is characterized by good survival rate, high freedom from reoperation and low incidence of complications.</p>

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<p><strong>Aim.</strong> The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. <br /><strong>Methods.</strong> The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. <br /><strong>Results.</strong> In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range.<br /><strong>Conclusion.</strong> The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.</p><p>Received 21 June 2016. Accepted 21 October 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A.<br />Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V.<br />Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A.<br />Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. <br />Review &amp; editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.</p>

We revealed high informativeness of NT-proBNP to predict postoperative atrial fibrillation after on-pump coronary artery bypass grafting.

<p><strong>Aim.</strong> The aim of this study is to show the outcomes of an open intervention on the ascending aorta and arch combined with stenting of aorta in type I aortic dissection.<br /><strong>Methods.</strong> 6 patients with type I aortic dissection underwent implantation of Djumbodis® Dissection System bare stents at I.M. Sechenov First Moscow Medical University’s Aortic and Cardiovascular Surgery Clinic. In 4 patients, aortic stenting was combined with ascending aorta replacement, in 1 patient, hemiarch ascending aorta and arch replacement was performed and in 1 patient aorta and arch replacement was complemented with a Sun procedure.<br /><strong>Results.</strong> Total operation time, cardiopulmonary bypass time, cross clamp time and hypothermic circulatory arrest time were just similar to those performed in conventional open surgery. There were no intraoperative deaths in this series. 30-day mortality was 16.7 % (1 patient). The patient died because of progressive respiratory and cardiovascular failure, encephalopathy, and gastrointestinal bleeding. 1 patient had acute renal failure and left leg ischemia because of the false lumen thrombosis, 1 patient suffered from cardiac tamponade and 1 patient underwent prolonged mechanical ventilation. Total false lumen thrombosis developed in 1 patient, 4 patients had partial false lumen thrombosis, and in 1 patient the false lumen remained patent.<br /><strong>Conclusion.</strong> Stenting of aortic arch and descending aorta is a good alternative to aortic arch replacement in type I aortic dissection. It promotes stabilization of false and true lumen diameters and global aortic diameter.</p><p>Received 18 October 2016. Accepted 7 November 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Komarov R.N., Soborov M.A.<br />Material acquisition and analysis: Karavaykin P.A. <br />Project curation: Komarov R.N., Belov Yu.V.<br />Article writing: Karavaykin P.A. <br />Review &amp; editing: Komarov R.N., Belov Yu.V., Soborov M.A.</p>

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Со времени первой успешной операции на дуге аорты (ДА) [7] достижения в анестезии, хирургической технике и послеоперационном ведении больных позволяют успешно выполнять операцию на ДА с защитой головно-го мозга (ГМ) для большинства пациентов [5, 6, 26, 27]. Появление методов альтернативной технологии защиты ГМ с результатами клинических и экспериментальных работ по гипотермическому циркуляторному аресту

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