Atherosclerosis is the most common cardiovascular disease and is the number one cause of death worldwide. Today, atherosclerosis is a multifactorial chronic inflammatory disease with an autoimmune component, accompanied by the accumulation of cholesterol in the vessel wall and the formation of atherosclerotic plaques, endothelial dysfunction, and chronic inflammation. In the process of accumulation of atherogenic lipids, cells of the immune system, such as monocytes, macrophages, dendritic cells, etc., play an important role, producing and/or activating the production of various cytokines—interferons, interleukins, chemokines. In this review, we have tried to summarize the most important cytokines involved in the processes of atherogenesis.

Aim. The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. Methods. The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. Results. In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range.Conclusion. The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.Received 21 June 2016. Accepted 21 October 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsConceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A.Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V.Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A.Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. Review & editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.

We present early results and long-term follow-up after reduction aortoplasty with external wrapping of the ascending aorta. From December 1993 to February 2008, 32 consecutive patients who had reduction aortoplasty were compared with 47 consecutive patients who underwent prosthetic graft replacement of the ascending aorta. The groups were similar in baseline characteristics. Patients in the reduction aortoplasty group had significantly shorter aortic crossclamp times (18.78 ± 1.91 vs. 34.04 ± 3.25min) and cardiopulmonary bypass times (30.16 ± 2.36 vs. 60.83 ± 2.05 min), and they received fewer transfusions. There was no significant enlargement of the aortic diameter at the level of the sinus of Valsalva in the reduction aortoplasty group during the follow-up period (from 38.84 ± 3.10 to 39.48 ± 2.72 mm). Reduction aortoplasty with external wrapping of the ascending aorta is a simple and promising surgical method. Our experience shows that this technique is the procedure of choice in patients without aortic dissection and with an appropriately sized sinus of Valsalva.

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Surgical treatment of patients with thoracoabdominal aneurysm is still actual problem in cardiovsacular surgery. We have retrospectively analyzed 344 treated patients. Thoracoabdominal aneurysms Crawford I-IV and descending aortic aneurysms were diagnosed in 186 (54,1%) and 158 (45,9%) patients respectively. For the follow-up period surgical mortality in case of thoracoabdominal aneurysms has been decreased to 8.9%. According to our opinion major predictors of adverse events are extended reconstruction (р=0.0086), intraoperative blood loss over 4.5 liters (р=0.003) and postoperative renal failure (р=0.0005). 2-fold decrease of blood loss was observed if «bag handle» technique introduced by us was applied (р=0.0042). Organs protection is provided by using of active selective blood perfusion as well as «Custodiol» infusion. Herewith safe period of absolute ischemia ranges from 30 to 50 minutes in normothermia. Development of «hybrid» methods significantly reduced incidence of complications. We consider that patients with thoracoabdominal aneurysm and dissection are candidates for «hybrid treatment».

: OBJECTIVES: We present our first experience of using a new dissection-specific hybrid stent graft (SG) (the ‘Soft Elephant Trunk’) in the frozen elephant trunk technique, in patients with non-acute DeBakey type I aortic dissection. METHODS: Between September 2016 and February 2021, patients with non-acute DeBakey type I aortic dissection underwent the frozen elephant trunk procedure at our centre using 3 SG types: group Z used stiff, distal Z-shaped nitinol SGs (E-Vita, Medtronic); group R used a stiff, ring-shaped nitinol SG (Thoraflex); and group S used a soft, distal dissection-specific SG. Predictors of distal SG-induced new entry were analysed. End points were hospital- and midterm-follow-up results. RESULTS: The study comprised 109 patients with 46 (42.2%), 22 (20.2%) and 41 (37.6%) patients in groups Z, R and S, respectively. No significant differences were found in early outcomes. Freedom from distal SG-induced new entry was comparable in groups Z, R and S (68.9% vs 92.9% vs 100%, log-rank = 0.14). There was no significant difference in follow-up between the groups. Four-year survival rates were 80.44%, 71.59% and 95.06% in groups Z, R and S, respectively. On multivariable analysis, the presence of connective tissue disorders [hazard ratio (HR) = 5.62, P = 0.11] and SG diameter (HR = 1.37, P = 0.034) were strong predictors of distal SG-induced new entry. CONCLUSIONS: Dissection-specific hybrid SG with a soft distal end is effective in patients with non-acute DeBakey type I aortic dissection. Compared to non-soft distal SGs, this can reduce the incidence of distal complications. Long-term outcomes are necessary to determine the potential advantages and disadvantages of the new prosthesis.