Kravchenko V. Problems of surgical treatment of aortic arch aneurysms

The study is devoted to solving various aspects of the problem of surgical treatment of aortic arch aneurysms. The aim of the study is to improve the results of surgical treatment of patients with ascending and aortic arches, taking into account the prediction and individualization of surgical tactics by improving the protection of the brain and visceral organs, development and implementation of a differentiated approach to surgical treatment.Based on the analysis of examination results and surgical interventions of 419 patients with proximal aortic aneurysms, data were obtained, on the basis of which scientific and theoretical provisions for the formation of pathogenesis, diagnosis, prognosis, prevention and comprehensive treatment of patients were developed. The study was conducted on the basis of the department of surgical treatment of aortic pathology of the State Institution "National Institute of Cardiovascular Surgery. M.M. Amosov National Academy of Medical Sciences of Ukraine «from 1994 to 2018. The study included 419 patients with a diagnosis of ascending aneurysm and aortic arch (AA) (including aortic dissection, or intramural hematoma). The age of patients varied in a wide range - from 22 to 60 years, all of them were patients of working age. The results of treatment of 14 pregnant women with aortic aneurysms who received treatment at the National Institute of Cardiovascular Surgery. M.M. Amosov National Academy of Medical Sciences of Ukraine". Tactics of treatment was developed in conjunction with specialists of the State Institution "Institute of Pediatrics, Obstetrics and Gynecology. Academician O.M. Lukyanova National Academy of Medical Sciences of Ukraine ". To study the pathogenesis of AA, namely possible metabolic disorders in patients with AA, a separate group of 30 patients with abdominal and thoracic AA without a complicated course and 28 healthy volunteers as a control group was formed. The results of surgical treatment of 53 patients who underwent hybrid interventions for the period from 2013 to 2018 were analyzed separately. Research methods: history taking and examination - for preoperative diagnosis (general and special methods of laboratory and instrumental diagnosis). In the study of the pathogenesis of the development of aortic aneurysms performed pathomorphological study - to determine structural changes in the aortic wall, enzyme-linked immunosorbent assay - to determine vascular endothelial growth factor (VEGF), study of metalloproteinase / tissue inhibitors (MPP-9 and its TIMP-2 inhibitor), cytokines (IL-6 and IL-10), immunological study - to determine the factors of specific and nonspecific resistance. When summarizing the results and forming conclusions, statistical analysis was used using the methods of parametric and nonparametric statistics.