Abstract
The simultaneous surgical interventions in cases of type I and type IIA aortic dissection with reconstruction
of brachiocephalic arteries are carried out even more often. However, redo ascending aorta and aortic arch
surgery with prosthetic repair of its branches are exclusive. We present the case in which similar operation
was performed in this report. During the surgery, a prosthetic repair of the brachiocephalic trunk had been
executed at first, and then CPB with moderate hypothermia via common femoral artery and brachiocephalic
prosthesis was established and the distal part of the ascending aorta was replaced with dacron graft.
Further, visceral perfusion via femoral artery was stopped and a prosthetic repair of hemiarch with open distal
anastomosis with the same graft under selective antegrade bilateral cerebral perfusion and circulatory
arrest was executed. At the final stage, the common CPB was restarted and brachiocephalic prosthesis
implanted into the aortic graft. Thus, patients after ascending aortic replacement in cases of acute type I and
type IIA aortic dissection need in regular observation to timely revealing of progressing of distal dissection.
Use of non-standard “adaptive” perfusion allowed to reduce circulatory arrest time and to execute intervention
in moderate hypothermia.
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