STEPWISE APPLICATION OF AORTIC WALL AUTOPLASTY, VAС-SYSTEM AND COMBINED STERNO-OSTEOSYNTHESIS IN TANDEM CARDIAC SURGICAL COMPLICATIONS IN ONE PATIENT

This paper describes the effective management of successive early postoperative complications, using aortic wall autoplasty, VAC-system, with completion of combined sterno-osteosynthesis in one cardiac surgical patient. The paper presents a clinical case of management of postoperative complications in a 67-year-old patient after aortic valve replacement and three-vessel myocardial revascularization by applying a combined and step-by-step approach for each complication: 1. In case of surgical bleeding - formation of flap plasty of the damaged aortic wall with autopericardium by in situ fixation method; 2. In case of profuse bleeding - application of VAC-system; 3. In case of high risk of sternum divergence - its closure by preferential rheosteosynthesis with tie-fixation devices. The described methods of control, carried an individual approach and the choice of the optimal method of their application, which requires knowledge of the entire arsenal of relevant and effective ways of emergency elimination of complications. In our case, unfortunately, against the background of successful one-stage treatment of all complications, the outcome was unfavorable, due to the exhaustion of compensatory mechanisms of the body against the background of severe combined acquired cardiac pathology. Autopericardium plasty by the method of fixation on the stem created additional protection of the aortic bleeding zone, and further installation of the VAC-system successfully stopped the uncontrollable non-surgical bleeding that was festering. Clamp-buckle osteosynthesis, which we applied as a standard in reoperations, contributed to more active intensive care in intensive care with improved repair of the sternum.