SURGICAL TREATMENT OF A PATIENT WITH ACUTE TYPE A AORTIC DISSECTION COMPLICATED BY CEREBRAL MALPERFUSION USING ADAPTIVE PERFUSION AND THE BRANCH-FIRST TECHNIQUE

Vollständiger Abstract

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A clinical case of surgical treatment of a 50-year-old patient with acute type A aortic dissection complicated by severe cerebral malperfusion and extension of the dissection into the brachiocephalic arteries is presented. Multislice CT revealed dissection of the brachiocephalic trunk with false lumen thrombosis, stenosis of the right common carotid artery, critical stenosis and false lumen thrombosis of the left common carotid artery, as well as involvement of the left subclavian artery. Given the high risk of perioperative cerebral ischemia, the operation was initiated with branch-first reconstruction of the brachiocephalic arteries using a trifurcated graft. After restoration of controlled cerebral perfusion, replacement of the ascending aorta and aortic arch was performed under adaptive cerebral perfusion. Cardiopulmonary bypass time – 232 min, cross-clamp – 101 min, and circulatory arrest – 36 min. The postoperative course was complicated by respiratory and renal failure requiring hemodialysis. The patient was discharged on postoperative day 30 in satisfactory condition.