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.

OBJECTIVES: Our goal was to present our experience with a hybrid approach to the frozen elephant trunk (FET) technique for the treatment of patients with chronic type B aortic dissection. METHODS: Between January 2013 and July 2019, 86 patients underwent the FET procedure at our centre. In 20 patients, the indication was chronic type B aortic dissection with a concomitant proximal aortic lesion. We evaluated the sites of proximal and distal entries, luminal communication and originating visceral branches in the computed tomography scan data. Primary end points were hospital deaths, complications and follow-up survival. Secondary end points included reintervention, thrombosis of the false lumen and aortic remodelling. RESULTS: There were no deaths, neurological complications or paraplegia during hospitalization; however, a few patients (10%) had temporary acute renal failure or required secondary aortic reintervention during the follow-up period. We performed thoracic endovascular aortic repair with stable aortic remodelling during follow-up. The follow-up survival rate was 92.3%, and 87.5% of cases did not require aortic reintervention. CONCLUSIONS: The FET technique is an effective method for treating chronic Stanford type B aortic dissection in patients at high risk of retrograde type A aortic dissection, concomitant disease of the proximal aorta and unsuitable anatomy for thoracic endovascular aortic repair, which allows for single-stage radical correction. Compared with thoracic endovascular aortic repair, the FET technique excludes the risk of type Ia endoleak, retrograde type A aortic dissection and possible stent graft migration. This technique provides comparable midterm follow-up outcomes and freedom from reintervention.

: 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.

Aim      Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM). Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6 %) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1–38 months (min-max) in the MS group and 42±21 (1–61 months (min-max) in the CS group. Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (р=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005). Conclusion The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients’ stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.

To report our own experience of hybrid treatment using FET technique in patients with type A aortic dissection and concomitant lesion of aortic arch and ascending aorta. There were 90 (28,3%) FET procedures for the period from January 2010 to August 2019. Type B aortic dissection was diagnosed in 19 (45,2%) patients. Type B aortic dissection combined with aortic arch aneurysm occurred in 11 (58%) cases, ascending aorta aneurysm - 15 (79%) cases. Patients underwent total arch and ascending aorta replacement via median sternotomy (upper partial J-shaped sternotomy in 3 cases). Valve-sparing interventions were performed in 58% of cases (aortic root repair - 6 (32%) patients, David procedure - 5 (26%) cases). Intraoperative features, early postoperative morbidity and in-hospital mortality were retrospectively analyzed. In long-term period, distal aortic remodeling, survival rate and incidence of redo interventions were evaluated. Mean CPB time was 166±27 min, aortic cross-clamping time - 93±23 min, duration of circulatory arrest - 43±11 min. Neurological complications and paraplegia were absent. In-hospital mortality was absent. Reversible acute renal failure without need for hemodialysis developed in 2 cases (11%). Two patients underwent repeated intervention (TEVAR) due to dSINE and negative aortic remodeling. Annual survival rate was 100%. Freedom from redo aortic surgery was 89,5%. FET surgery is an adequate alternative treatment for type B aortic dissection combined with lesion of aortic arch and ascending aorta. This approach ensures a one-stage repair in patients with contraindications to TEVAR. Unlike thoracotomy, FET procedure is valuable for simultaneous correction of cardiac and proximal aortic lesion, stabilizing the distal segments of dissected aorta. This is obvious advantage of this technique.

ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнить методики этапного и одномоментного подходов по замене всей аорты при хирургическом лечении пациентов с синдромом мегааорты, используя собственный и мировой опыт. Этапный подход с использованием открытых и гибридных методов до сих пор остается методом выбора для хирургического лечения пациентов с синдромом мегааорты. В настоящее время в ФГБНУ «РНЦХ им. акад. Б.В. Петровского» активно развивается направление одномоментного лечения патологии всей аорты, которое показало потенциальные преимущества перед этапным подходом. Мы представляем наш опыт лечения тяжелой категории больных с синдромом мегааорты с использованием различных методов. МАТЕРИАЛ И МЕТОДЫ В исследование включены 49 пациентов с синдромом мегааорты, которым с мая 2015 г. по март 2021 г. выполнена замена всей аорты от уровня синотубулярного гребня (при этапном протезировании в случае необходимости также выполнялась коррекция патологии корня аорты) до бифуркации аорты. Все вмешательства были плановыми. Пациентов разделили на две группы: 1-ю группу — 33 (67,3%) пациента с этапной заменой и 2-ю группу — 16 (32,7%) пациентов с одномоментной заменой всей аорты с применением торакофренолюмботомического доступа. Первичные конечные точки исследования — летальность, периоперационные параметры и осложнения. Важными параметрами оценки результатов также являлись отдаленные исходы — свобода от реопераций на аорте и выживаемость. РЕЗУЛЬТАТЫ Группы сопоставимы по основным периоперационным параметрам. Интервал между операциями при этапном протезировании составил 7,1±2,3 мес. Сроки реабилитации с учетом двух этапов были больше у пациентов 1-й группы (13±2 мес по сравнению с 5,5±1,1 мес, p=0,0001). Летальность между этапами составила 12% (n=4). Интраоперационная летальность отсутствовала в обеих группах. Госпитальная летальность в группах составила 3% и 12% (p=0,25), суммарная летальность с интервалом между этапами — 10,2% по сравнению с 12% (p=1,000) в 1-й и 2-й группах соответственно. Длительность наблюдения в 1-й и 2-й группах статистически значимо не различалась и составила 18±22,7 (1—71) мес и 23,3±19,1 (1—51) мес (p=0,63) соответственно. 1-летняя, 3-летняя и 5-летняя выживаемость с учетом летальности между этапами в 1-й группе составила соответственно 89% (95% ДИ 78—100%), 77,1% (95% ДИ 60,1—98,8%) и 77,1% (95% ДИ 60,1—98,8%); 1-летняя и 3-летняя выживаемость во 2-й группе составила 86,5% (95% ДИ 70,5—100%), Log-rank p=0,88. Кумулятивная свобода от повторных вмешательств составила в 1-й группе 92,9% (95% ДИ 80,3—100%), во 2-й группе — 90,9% (95% ДИ 75,4—100%), Log-rank p=0,072. ВЫВОДЫ Одномоментная замена всей аорты с применением торакофренолюмботомического доступа является безопасным методом хирургического лечения синдрома мегааорты, особенно у молодых пациентов низкого хирургического риска, и обеспечивает удовлетворительные результаты при выполнении в центрах с большим опытом операций на аорте. По сравнению с этапным подходом одномоментная замена аорты исключает риск разрыва аорты в интервале между этапами, поэтому она является достойной альтернативой существующим методам.