Truba Y. Problems of surgical treatment of aortic arch hypoplasia in newborns and infants

The dissertation contains a theoretical substantiation and a practical solution of a topical scientific problem in the field of medicine - surgical treatment of aortic arch hypoplasia in newborns and infants. The study material consisted of 445 consecutive patients under 1 year of age, who from 2010 to 2019 underwent surgical treatment of aortic arch hypoplasia. The study included patients with hypoplasia of one or more segments of the aortic arch in the form of isolated pathology, and in combination with concomitant airways, which can be treated by ventricular correction. The exclusion criteria from the study group were concomitant CHD with single-ventricular physiology.The overall mortality of the entire study group was 3.3%. Hospital mortality was 2.7%, mortality in the long term - 0.7%. Survival of patients was: after 6 months. - 97.8%, after 1 year - 96.9% [94.9-98.7; 95% SI], and was constant over the next 10 years of follow-up. The follow-up period ranged from 1 month to 10.9 years, with 416 patients (93.4% of the total number of patients who underwent surgery).A comparative evaluation of the criteria for the diagnosis of aortic arch hypoplasia by calculating positive and negative results was performed. When comparing different criteria for determining aortic arch hypoplasia, it was found that the highest sensitivity of 98.9% is characteristic of the Z-score criterion. The specificity of this method of calculating hypoplasia was 92.6%, positive and negative prognostic value was 97.6% and 35.2%, respectively. The choice of correction method was based on the presence of hypoplasia of a segment of the aortic arch. The paper proves that selective antegrade cerebral perfusion with moderate hypothermia is an effective and safe method of brain protection in the reconstruction of the aortic arch in infants from the middle access in the conditions of artificial circulation. In the course of the study, mathematical models for predicting immediate and long-term results were created, which allow to perform an individual prognosis of survival with high sensitivity (from 75.3% to 88.2%) and specificity (from 75% to 86%), to determine the risk of restenosis, repeated operations, helping to optimize the choice of surgical treatment tactics.