[MODERN TECHNOLOGIES OF THE SAVING OF PATIENT'S BLOOD AND REDUCTION OF THE USE OF DONOR BLOOD DURING OPERATIONS ON THE ASCENDING AORTA AND AORTIC ARCH].

Questions of saving of the patient's blood and limitation of the use of donated blood in the aortic surgery remain relevant in contrast with interventions on the valves of the heart and coronary arteries. In this regard, the aim of the study was to develop and introduce ofcomplex of technologies for saving the patient's blood in order to minimize transfusion of donor blood components during operations on the ascending aorta and aortic arch under hypothermic arrest. The study included 37 patients operated on the ascending aorta and aortic arch under cardiopulmonary bypass (CPB) and hypothermic cardiac arrest (CA) in 2013-2014 (Group 1). 2nd group consisted of 65 patients who at the same time performed reconstructive surgery on the ascending aorta with CBP without stopping the blood circulation. The comparative aspect studied the following parameters: duration of the CBP, CA, temperature, volume of intraoperative and postoperative blood loss, frequency of use of donor blood components autoplasma, washed red blood cells, autologous blood, hemostatic agents, the frequency resternotomy, hematocrit dynamics, glucose, and blood lactate. Comparative studies have shown that the amount of intraoperative blood loss during operations on the aortic arch under the CA was 1294 ± 303 mL, 20% higher than the blood loss during operations on the ascending aorta without CA. Program of saving of the blood of patients with aortic disease included preoperative preparation of autoplasma in 60% of patients, intraoperative collection and laundering of autoerythrocytes in 40-70% of patients and autotransfusion modified method, the improvement of surgical and pharmacological hemostasis and monitoring. Design and implementation of these methods reduced the patients need for donor red blood cells (from 76 to 47%), fresh frozen plasma (from 65 to 35%) during the operation at the aortic arch and the ascending aorta and to completely avoid the use of donor blood in 25% of patients. Proof of the adequacy of the developed strategy of conservation and limitation of the patient's blood was allogeneic blood conservation targets hemoglobin, hematocrit levels and metabolism at the end of the operation.

[ANAESTHETIC MANAGEMENT OF RECONSTRUCTIVE SURGERY ON THE AORTIC ARCH: THE NUANCES OF ORGAN PROTECTION].

UNLABELLED: Aortic arch reconstruction is one of the most difficult surgical procedures. Therefore the aims of our study were: to choose appropriate flow rate for antegrade cerebral perfusion and assess its adequacy in relation to cerebral metabolic demands; to evaluate safety of temperature settings during the surgery; to assess the effectiveness of chosen protocol for brain and visceral organ protection during aortic arch reconstruction surgery. Our study included 67 patients. Patients of the first group (n = 33) underwent aortic arch reconstruction with antegrade cerebral perfusion and hypothermic circulatory arrest (target core temperature 26 °C). The second group (n = 34) underwent ascending aorta repair using cardiopulmonary bypass with modest hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all patients. In the first group transcranial Doppler monitoring and jugular venous bulb catheterization were performed. Target core temperature during rewarming was 36 °C. In the first group air-warming device in addition to fluid warming was used. In all patients cognitive function was assessed before and after surgery. The multimodal monitoring allowed to dynamically adjust flow rate of antegrade cerebral perfusion. As a result cerebral SO2 and linear velocity were maintained in acceptable range, while flow rate varied significantly from 5.8 to 16.5 ml/ kg/min (average rate 13.4 ± 3.69 ml/kg/min). CONCLUSION: Combined use of cerebral oximetry and transcranial Doppler monitoring allows assessing how oxygen delivery meets metabolic demands of the brain during antegrade cerebral perfusion. This method allows to maintain the proper flow rate of antegrade cerebral perfusion and to choose an appropriate modification of perfusion (unilateral vs bilateral). Multichannel monitoring of core temperature and combined use of air- and fluid warming techniques are required for effective temperature management.