Buchneva O. Complex tactics of surgical treatment of acute aortic diseases

The dissertation is a clinical and experimental research and includes the development, implementation, testing of advanced technologies for surgical intervention in acute aortic lesions, reconstructive and reconstructive operations. The results of surgical treatment of 484 patients with acute surgical diseases of the aorta were analyzed. Mortality in operations for acute aortic diseases largely depends on blood loss during surgery. Ultrasound examination has high specificity in determining compared with MSCT, and can be used as the only preoperative examination method in patients requiring emergency surgery. With a high level of apoptosis markers and immune-inflammatory molecules, a steady tendency to hypo coagulation during therapy was observed, as well as more severe damage to the aortic walls according to the results of morphological studies. Using the developed technique of surgical intervention on the ascending aorta and the arch without deep hypothermia and circulatory arrest, due to the preservation of blood flow in the aorta during surgery, allows to reduce damage to internal organs from 54% to 14,2%. In operations on the descending aorta, the use of the left atrial-femoral bypass determines a smaller amount of damage to internal organs from 64,1% to 25,6% and the number of complications in its use. Reinfusion of autologous blood, together with the use of developed surgical techniques, can reduce mortality in all types of clinical course of acute aortic diseases from 52% to 27%. End bronchial administration of surfactant is a clinically effective way of treating acute manifestations of respiratory distress syndrome in patients operated on for acute aortic diseases, which can significantly reduce the time for normalization of oxygenation. Vascular patches made of polyethylene terephthalate - lavsan material presented with a cloth with a knitted base have the least disorganizing effect on the fibrous skeleton of the aorta wall among the studied implants at different terms of the study. The developed treatment tactics for patients with acute aortic diseases made it possible to reduce mortality from 45% to 2,5% and complications from 75% to 27%. Key words: acute aortic diseases, dissecting aneurysm, aortic rupture, homeostasis, reconstructive interventions, surgical tactics.