grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-4625Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2025-184-1-99-106grekov-2539Research ArticleОБЗОРЫREVIEWSЗащита головного мозга при хирургических вмешательствах на дуге аорты: современное состояние проблемыBrain protection during aortic arch surgery: current state of problemhttps://orcid.org/0000-0003-1505-0847ХомушкуД. В.KhomushkuD. V.

Хомушку Дадар-оол Валерьевич, аспирант отделения хирургии аорты и коронарных артерий

630055, г. Новосибирск, ул. Речкуновская, д. 15

Khomushku Dadar-ool V., Postgraduate Student of the Department of Surgery of the Aorta and Coronary Arteries

15, Rechkunovskaya str., Novosibirsk, 630055

dadarool_khomushku@mail.ruhttps://orcid.org/0000-0002-9940-3541СиротаД. А.SirotaD. A.

Сирота Дмитрий Андреевич, доктор медицинских наук, зав. научно-исследовательским отделом хирургии аорты, коронарных и периферических артерий института патологии кровообращения, врач-сердечно-сосудистый хирург отделения хирургии аорты и коронарных артерий, Национальный медицинский исследовательский центр имени академика Е. Н. Мешалкина; ассистент кафедры сердечно-сосудистой хирургии факультета повышения квалификации и профессиональной переподготовки, Новосибирский государственный медицинский университет

630055, г. Новосибирск, ул. Речкуновская, д. 15

630091, г. Новосибирск, Красный пр., д. 52

Sirota Dmitry A., Dr. of Sci. (Med.), Head of the Research Department of Surgery of the Aorta, Coronary and Peripheral Arteries of the Institute of Circulatory Pathology, Cardiovascular surgeon, Department of Aortic and Coronary Artery Surgery, National Medical Research Center named after Academician E. N. Meshalkin; Assistant of the Department of Cardiovascular Surgery, Faculty of Advanced Training and Professional Retraining, Novosibirsk State Medical University

15, Rechkunovskaya str., Novosibirsk, 630055

52, Krasny pr., Novosibirsk, 630091

https://orcid.org/0000-0002-1176-8125ШадановА. А.ShadanovA. A.

Шаданов Алдар Андреевич, врач – сердечно-сосудистый хирург отделения хирургии аорты и коронарных артерий

630055, г. Новосибирск, ул. Речкуновская, д. 15

Shadanov Aldar A., Cardiovascular Surgeon, Department of Aortic and Coronary Artery Surgery

15, Rechkunovskaya str., Novosibirsk, 630055

https://orcid.org/0000-0002-6661-7826ЕдемскийА. Г.EdemskiyA. G.

Едемский Александр Геннадьевич, кандидат медицинских наук, врач – сердечно-сосудистый хирург отделения хирургии аорты и коронарных артерий

630055, г. Новосибирск, ул. Речкуновская, д. 15

Edemskiy Alexander G., Cand. of Sci. (Med.), Cardiovascular Surgeon of the Department of Surgery of the Aorta and Coronary Arteries

15, Rechkunovskaya str., Novosibirsk, 630055

https://orcid.org/0000-0001-9818-8678ЧернявскийА. М.ChernyavskiyA. M.

Чернявский Александр Михайлович, доктор медицинских наук, профессор, чл.-корр. РАН, заслуженный деятель науки РФ, генеральный директор, Национальный медицинский исследовательский центр имени академика Е. Н. Мешалкина; зав. кафедрой сердечно-сосудистой хирургии факультета повышения квалификации и профессиональной переподготовки врачей, Новосибирский государственный медицинский университет

630055, г. Новосибирск, ул. Речкуновская, д. 15

630091, г. Новосибирск, Красный пр., д. 52

 

Chernyavskiy Alexander M., Dr. of Sci. (Med.), Professor, Corresponding Member of the RAS, Honored Scientist of the Russian Federation, General Director, National Medical Research Center named after Academician E. N. Meshalkin; Head of the Department of Cardiovascular Surgery, Faculty of Advanced Training and Professional Retraining of Physicians, Novosibirsk State Medical University

15, Rechkunovskaya str., Novosibirsk, 630055

52, Krasny pr., Novosibirsk, 630091

Национальный медицинский исследовательский центр имени академика е. Н. МешалкинаРоссияNational Medical Research Center named after Academician E. N. MeshalkinRussian FederationНациональный медицинский исследовательский центр имени академика е. Н. Мешалкина; Новосибирский государственный медицинский университетРоссияNational Medical Research Center named after Academician E. N. Meshalkin; Novosibirsk State Medical UniversityRussian Federation202527042025184199106Copyright © Хомушку Д.В., Сирота Д.А., Шаданов А.А., Едемский А.Г., Чернявский А.М., 20252025Хомушку Д.В., Сирота Д.А., Шаданов А.А., Едемский А.Г., Чернявский А.М.Khomushku D.V., Sirota D.A., Shadanov A.A., Edemskiy A.G., Chernyavskiy A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2539

Хирургия дуги аорты является одним из самых сложных разделов сердечно-сосудистой хирургии. Реконструктивные вмешательства на дуге аорты сопряжены с высокими рисками из-за особенностей анатомии и технической сложности вмешательства. Для защиты головного мозга во время операции на дуге аорты широко применяется антеградная перфузия головного мозга в сочетании с гипотермией. Антеградная перфузия может выполняться в унилатеральном или билатеральном варианте. На данный момент отсутствуют четкие рекомендации относительно ведения пациентов, оперируемых на дуге аорты. В данном обзоре освещены основные методы защиты головного мозга в аортальной хирургии, а также представлены результаты имеющихся исследований, сравнивающих унилатеральную и билатеральную перфузии головного мозга. Рассмотрены обоснования различных исследователей при выборе каждой из двух предложенных методик для снижения риска неврологических осложнений.

Aortic arch surgery is one of the most challenging field of cardiovascular surgery. Reconstructive interventions on the aortic arch are associated with high risks due to the peculiarities of anatomy and technical complexity of surgical intervention. Antegrade cerebral perfusion in combination with hypothermia is widely used to protect the brain during aortic arch surgery. Antegrade cerebral perfusion can be performed in unilateral or bilateral way. Now, there is no clear guidelines regarding the management of patients operated on the aortic arch. This review highlights the main methods of protecting the brain during aortic arch surgery and shows the results of the studies comparing antegrade unilateral brain perfusion with bilateral one. We reviewed rationale of various researchers in choosing two proposed methods to reduce the risk of neurological complications.

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The authors declare that there are no conflicts of interest present.