[Various technics in the surgical treatment of dissection of the thoracic aorta]

During 1994-1996 at the Clinic of Cardiovascular and Transplantation Surgery of IKEM 17 patients were operated with acute dissection of the thoracic aorta type A. Based on the applied surgical tactics the patients were retrospectively divided into two groups. The first included 8 patients where surgical reconstruction of the ascending aorta was implemented in the standard way, the second group comprised 9 patients where the method of deep hypothermia and circulatory arrest were used. Three operated patients died, all from the group with deep hypothermia. The cause of death was twice multiorgan failure and once haemorrhage in a female patient with cardiac tamponade before surgery. The authors discuss the advantages and some pitfalls of surgery in deep hypothermia and circulatory arrest and maintain that neurological disorders are most serious. In the conclusion they draw attention to some possible ways how to improve hitherto achieved results. They include e.g. reduction of the time interval between the development of symptoms of dissection and surgery, careful checking of the cooling and heating when using deep hypothermia, as well as better prevention of cerebral embolic attacks.