Aim. Assessment of normal and variant aortic arch anatomy in patients with type A aortic dissection and aneurysm of the arch and descending thoracic aorta.Methods. We retrospectively studied computer tomography (CT) data of chest organs with contrast in patients who underwent reconstruction of the aortic arch in type I aortic dissection according to DeBakey classification (n = 61) and resection of the aortic arch and descending thoracic aorta aneurysm (n = 14) at the Meshalkin National Medical Research Center, Novosibirsk, Russian Federation. The control group included patients without aortic arch pathology (n = 52). To identify relationships between the anatomical type of aortic arch and the risk of aortic pathology development, univariate and multivariate binary logistic regression analyses were used.Results. Our analysis revealed four types of aortic arch anatomy. Normal aortic arch anatomy occurred in 66.1 % of patients (n = 84), the proportion of abnormalities of the left common carotid artery was 30 % (bovine aortic arch occurred in 15 %, and the same site of origin of left common carotid artery and brachiocephalic trunk occurred in 15 %). Divergence of the left vertebral artery from the aortic arch between the left common carotid and left subclavian arteries occurred in 3.1 % (n = 4), and the combination of “bovine trunk” and divergence of the left vertebral artery from the aortic arch was detected in 0.8 % patients (n = 1). Logistic regression analyses revealed no statistically significant relationships between variant aortic arch anatomy and the development of type A aortic dissections and aortic arch aneurysms. The presence of the common origin of brachiocephalic trunk and left common carotid artery was associated with a reduced risk of acute aortic dissection type I by 89 %, or an OR of 0.11 (95% CI: 0.03–0.46) (p = 0.002).Conclusion. Our data will help with future planning surgical interventions on the aortic arch and descending thoracic aorta. Received 17 June 2020. Revised 16 July 2020. Accepted 17 July 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: A.A. ShadanovData collection and analysis: A.A. Shadanov, T.A. BergenStatistical analysis: D.A. Sirota, A.A. ShadanovDrafting the article: A.A. ShadanovCritical revision of the article: D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: A.A. Shadanov, D.A. Sirota, T.A. Bergen, M.M. Lyashenko, A.M. Chernyavskiy

Background: One of the most feared long-term complications of surgical treatment of proximal aortic dissections is an aneurysm of the non-operated compartments of the aorta.Objective: To conduct a comparative analysis of different methods for surgical treatment of proximal aortic dissections in relation to false lumen thrombosis development in non-operated compartments.Methods: We conducted a simple observational retrospective multicenter study to study the effectiveness of the frozen elephant trunk technique compared with a standard surgical intervention (aggressive hemiarch anastomosis or total aortic arch replacement with a multibranched prosthesis). Our study included 101 patients grouped based on the method of treatment: group 1 for frozen elephant trunk (n = 31); group 2 for thoracic aorta reconstruction by the standard methods (control group, n = 70). Due to the retrospective nature of the study and the disparity of groups by certain characteristics, we used propensity score matching to increase the reliability of the results. All patient data were collected in the preoperative period, from the protocols of surgical interventions, in the postoperative and long-term periods (3-6 months, 1 year, 2 years, 3 years after surgery). All statistical calculations were conducted in the RStudio software, version 0.99.879 (RStudio Inc., Boston, USA).Results: The absence of false lumen thrombosis at the thoracic aorta level persisted after the surgical treatment in half of the patients in the control group (n = 13; 52%) and was not determined in the frozen elephant trunk group. Complete false lumen thrombosis at the thoracic aorta level (level of stent graft placement and distal to the diaphragm) was achieved in more than half of the patients in the frozen elephant trunk group and only in 3 (12%) control patients. Aneurysmal transformation of the non-operated aorta occurred in 12 (48%) patients from group 2 and was absent in group 1.Conclusion: The frozen elephant trunk technique reduces the frequency of aorto-related events to 0% within 3 years compared with the standard approach (32%, P < .005). Patients operated on for proximal aortic dissection using the frozen elephant trunk technique are significantly more likely to have false lumen thrombosis in the thoracic aorta (P = .004), significantly lower incidence of aneurysmal transformation or thoracic aorta growth rate of >5 mm per year in the long-term period (P = .016) compared with those who underwent the standard methods. Received 15 February 2023. Revised 31 July 2023. Accepted 4 August 2023. Funding: The study was carried out within the framework of the grant of the President of the Russian Federation НШ-5096.2022.3 (agreement No. 075-15-2022-823 dated 12.05.2022). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.M. Chernyavskiy, M.M. Lyashenko Data collection and analysis: M.M. Lyashenko, A.A. Shadanov, D.S. Panfilov, E.V. SkurikhinaStatistical analysis: M.M. LyashenkoDrafting the article: M.M. LyashenkoCritical revision of the article: A.M. Chernyavskiy, D.A. Sirota, B.N. KozlovFinal approval of the version to be published: A.M. Chernyavskiy, M.M. Lyashenko, D.A. Sirota, A.A. Shadanov, B.N. Kozlov, D.S. Panfilov, E.V. Skurikhina

Background: Vascular graft infection is a severe cardiovascular complication with high mortality rates. Antibacterial vascular graft coatings are widely used and continue to be improved.Objective: To develop a sealant with antimicrobial effect for Dacron vascular grafts and experimentally test the coating properties.Methods: We used 2 types of vascular grafts: graft No. 1 (plain weave) with initial water permeability of 78.8 ± 2.7 mL/cm2/min and graft No. 2 (2/1 twill + 6/4 satin weave) with water permeability of 549.8 ± 20.7 mL/cm2/min. We developed an original gelatin impregnation technique, tested it using a scanning electron microscopy, and measured water permeability and kink radius. We evaluated the antibacterial activity of vancomycin and gelatin impregnation by the disk diffusion test using media with Staphylococcus aureus ATCC 29213 and Enterococcus faecalis ATCC 29212 and measured inhibition zones after 24-hour incubation. We used samples cut out of grafts with vancomycin-containing (experimental group) and no vancomycin-containing (control group) impregnation.Results: The gelatin coating of the samples is visualized as a thin even film and provides zero water permeability. On the negative side, it increased stiffness and the kink radius. Thanks to vancomycin added to the coating, bacterial growth significantly inhibits: the mean diameter of the growth inhibition zone for Staphylococcus aureus and Enterococcus faecalis was 15.60 ± 0.65 and 14.40 ± 0.66 mm, respectively. The grafts untreated with vancomycin showed no growth inhibition zones.Conclusion: Vascular graft treatment with gelatin impregnation and vancomycin solution is a simple measure to prevent the growth of gram-positive bacteria on vascular grafts. Received 14 November 2022. Revised 15 December 2022. Accepted 19 December 2022. Funding: The work was supported by Russian Science Foundation (project No. 22-15-20005). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: I.Yu. Zhuravleva, A.A. Shadanov, D.A. SirotaData collection and analysis: A.A. Shadanov, L.M. Samoylova, S.V. Vladimirov, T.P. Timchenko, N.E. Luchnikov, E.V. KarpovaStatistical analysis: A.A. ShadanovDrafting the article: A.A. Shadanov, L.M. Samoylova, T.P. Timchenko, A.G. EdemskiyCritical revision of the article: D.A. Sirota, I.Yu. Zhuravleva, A.V. Bogachev-Prokofiev, A.M. ChernyavskiyFinal approval of the version to be published: A.A. Shadanov, I.Yu. Zhuravleva, L.M. Samoylova, T.P. Timchenko, S.V. Vladimirov, E.V. Karpova, N.E. Luchnikov, D.A. Sirota, A.G. Edemskiy, A.V. Bogachev-Prokofiev, A.M. Chernyavskiy

Among the vascular prostheses used for aortic replacement, 95% are woven or knitted grafts from polyester fibers. Such grafts require sealing, for which gelatin (Gel) is most often used. Sometimes antibiotics are added to the sealant. We used gelatin type A (GelA) or type B (GelB), containing one of the three antibiotics (Rifampicin, Ceftriaxone, or Vancomycin) in the sealant films. Our goal was to study the effect of these combinations on the mechanical and antibacterial properties and the cytocompatibility of the grafts. The mechanical characteristics were evaluated using water permeability and kinking radius. Antibacterial properties were studied using the disk diffusion method. Cytocompatibility with EA.hy926 endothelial cells was assessed via indirect cytotoxicity, cell adhesion, and viability upon direct contact with the samples (3, 7, and 14 days). Scanning electron microscopy (SEM) and energy dispersive spectrometry (EDS) were used to visualize the cells in the deep layers of the graft wall. “GelA + Vancomycin” and “GelB + vancomycin” grafts showed similar good mechanical characteristics (permeability~10 mL/min/cm², kinking radius 21 mm) and antibacterial properties (inhibition zones for Staphilococcus aureus~15 mm, for Enterococcus faecalis~12 mm). The other samples did not exhibit any antibacterial properties. The cytocompatibility was good in all the tested groups, but endothelial cells exhibited the ability to self-organize capillary-like structures only when interacting with the “GelB + antibiotics” coatings. Based on the results obtained, we consider “GelB + vancomycin” sealant to be the most promising.

Objective: The aim of this study was to evaluate the outcomes of autoarterial revascularization involving Y-composite grafts and in situ conduits out of the internal thoracic arteries (ITAs) at the hospital period and after a year follow-up.Methods: The study included 200 patients with coronary artery disease who underwent coronary bypass surgery over the period from March 2018 to March 2021. Patients were randomized using the envelope method into 2 groups: in the first group, autoarterial conduits out of the ITAs were used according to the in situ method (n = 100); in the second group, autoarterial conduits with the formation of a Y-composite grafts out of ITAs (n = 100) were put into practice. The primary endpoints of the study were the incidence of repeat revascularization and amount of major adverse cardiac and cerebrovascular events (MACCE).Results: There was no significant difference between the two groups in the level of freedom from MACCE; in the in situ and Y-composite groups the indicators were 97.9% (95% CI 92.1-99.5) and 94.8% (95% CI 88.1‑97.8; P = 0.24), respectively. In a year follow-up, freedom from repeated revascularization amounted to 97.9% in the in situ group (95% CI 92-99.4), and 97.9% in the Y-composite group (95% CI 91.9-99.4; P = 0.97). A significant difference was registered in the surgery duration, which in the in situ group lasted 235 [197.5; 252.5] minutes versus 252.5 [225; 290] minutes in the Y-composite group, P < 0.002. In the Y-composite group, the rate of infectious complications on the breast bone was significantly more frequent than in the in situ group (P < 0.023).Conclusion: Despite the hypothetical advantages of bimammar coronary bypass surgery over the Y-configuration one, this study did not reveal significant differences in outcomes between the in situ and Y-composite groups. Received 7 November 2023. Revised 10 June 2024. Accepted 24 June 2024. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: A.K. Sabetov, D.S. Khvan, M.O. ZhulkovData collection and analysis: A.K. SabetovStatistical analysis: A.A. Shadanov, A.K. SabetovDrafting the article: A.K. SabetovCritical revision of the article: D.A. Sirota, D.S. Khvan, A.M. ChernyavskiyFinal approval of the version to be published: A.K. Sabetov, D.A. Sirota, D.S. Khvan, M.O. Zhulkov, A.A. Shadanov, A.M. Chernyavskiy

Introduction: Acute aortic dissection of type A is a life-threatening condition where open surgical treatment is the "gold standard". The effect of prehospital double antiplatelet therapy (DAPT) on the results of surgical treatment has not been sufficiently studied. The available literature data indicate the ambiguity of the DAPT results in acute aortic syndrome. Objective: The study was aimed at assessing the effect of double antiplatelet therapy at the pre-hospital stage on the results of surgical treatment of acute aortic dissection type A. Methods: A retrospective analysis of the results of surgical treatment of patients with acute aortic dissection of type A was based on the patient database of Meshalkin National Medical Research Center. We analyzed 33 patients (DAPT group) who received double antiplatelet therapy at the pre-hospital stage and 63 patients (noDAPT group) without double antiplatelet therapy from non-matched cohort before the propensity score matching (PSM) analysis. After PSM analysis of the group, 29 pairs of patients were selected (a matched cohort). The primary endpoint was represented by a combination of events associated to bleeding, namely postoperative bleeding >1500 ml/12h, intraoperative wound tamponing and open bleeding revisions. Secondary, 30-day mortality, inhospital mortality and medium-term survival were evaluated before and after PSM analysis. The effect of preoperative DAPT on 30-day mortality was assessed using multivariate logistic regression analysis. Results: In the matched cohort, after PSM analysis for the primary endpoint, the distribution of patient between noDAPT and DAPT groups were 34.5% vs 51.7%, p = 0.210. In the DAPT group, fresh frozen plasma (p = 0.001) and red blood cell mass (p = 0.0009) were transfused significantly more frequently within 24 hours after surgery. There were no significant differences between the noDAPT and DAPT groups on indicators of 30-day mortality (10.3% vs 27.6%, p = 0.094) and 5-year survival (69% vs 60.9%, p = 0.357). In the multifactorial model of logistic regression analysis, DAPT was an independent predictor of 30-day mortality (OR 3.36 [95% CI, 1.02-11.04], p = 0.045); the combined primary endpoint, associated to bleeding indicators, increased its probability by 5 times (OR 4.98 [95% CI, 1.34-18.5], p = 0.016). Conclusion: Preoperative DAPT did not significantly increase either the incidence of bleeding-related events or the early mortality rate, and did not reduce mid-term survival in patients with acute type A aortic dissection. However, preoperative administration of DAPT was an independent predictor of 30-day mortality. Preoperative DAPT is not a limitation to surgical treatment of acute type A aortic dissection. Received 25 September 2024. Revised 13 October 2024. Accepted 15 October 2024. FundingThe study was carried out within the framework of project No. 22-15-20005 (agreement No. 22-15-20005 with the Russian Science Foundation, dated 22.03.2022, agreement No. р-12 with the Ministry of Science and Innovation Policy of the Novosibirsk Region, dated 13.03.2023). Conflict of interestThe authors declare no conflict of interest. Contribution of the authors Conception and study design: D.A. Sirota, A.A. Shadanov, M.M. Lyashenko, A.M. Chernyavskiy, M.N. MurtazalievData collection and analysis: M.N. Murtazaliev Statistical analysis: A.A. ShadanovDrafting the article: A.A. Shadanov, D.A. SirotaCritical revision of the article: D.A. Sirota, A.A. Shadanov, A.M. Chernyavskiy, M.M. LyashenkoFinal approval of the version to be published: D.A. Sirota, A.A. Shadanov, M.N. Murtazaliev, M.M. Lyashenko, A.M. Chernyavskiy