Treatment of patients in the immediate and long-term periods of acute aortic dissection of type A complicated by malperfusion syndrome

Introduction. Acute aortic dissection type A is still considered one of the most formidable conditions in urgent surgery. The occurrence of malperfusion significantly worsens the results of treatment, leading to an increase in the incidence of complications and mortality. Patients who have undergone reconstructive interventions in the acute period require dynamic observation due to the development of aortic remodeling, leading in some cases to repeated dissection. Aim. To improve the results of surgical treatment of patients with acute type A aortic dissection and malperfusion. Materials and methods. From 2006 to 2021, 117 patients with acute type A aortic dissection and malperfusion were treated at the Interregional Clinical and Diagnostic Center of the Ministry of Health of the Republic of Tatarstan, Kazan, 107 of whom received surgical treatment. Results. The following factors had a statistically significant impact on survival: aortic rupture with hemotamponade, myocardial infarction, anastomotic bleeding, renal and coronary malperfusion. The right coronary artery, brachiocephalic trunk, common carotid, renal and common iliac arteries had a significant effect (p < 0.05) on the occurrence of malperfusion with a true lumen narrowing degree of at least 60%. Remodeling of the aorta and its branches requiring correction occurred in every 5th (17%) case. Discussion. The introduction of new predictors of unfavorable outcome is an urgent problem; their dissemination and implementation makes it possible to modernize existing treatment methods. The problem of aortic remodeling in patients after acute dissection is the most pressing in modern aortic surgery, because repeated acute aortic syndrome against the background of the previous development of a more malignant disease. Conclusions. In the acute period, it is necessary to carefully assess the presence of risk factors and the degree of narrowing of the true branches of the aorta in order to reduce thelevel of complications and mortality. To prevent acute aortic syndrome, it is necessary to monitor pathological remodeling of the aorta.