Reconstructive surgery of the aortic root: algotithm for selecting surgery of the aortic root aneurysm depending on the anatomical and functional characteristics of the aortic valve

Introduction. Valve-sparing technologies still account for the smallest proportion of all surgeries performed for aortic root (AR) pathology. Despite the large number of modern surgical solutions, new technologies and procedures are still being developed and implemented in cardiac surgery. The Russian conduit (RC) procedure is a combination of the Bentall and Ozaki procedures, a method for replacing all structures of the AR.

Objective. To develop a surgical protocol for the treatment of AR aneutysm, based on the anatomical features of the aortic valve (AV) and the classification of aortic insufficiency (AI) types.

Materials and methods. The study included 198 patients with aneurysms of the root and/or ascending aorta with ≥ grade 2 AR who underwent the David, Yacoub, and RC procedures. Exclusion criteria: combined AV disease, acute aortic syndrome, minimally invasive procedures, and patients following the David procedure with cusps repair. 62 patients were divided into 3 groups: David – 36, Yacoub – 14, RK – 12.

Results. Patients with AI types Ia, Ib, and Ic accounted for more than 80 % of each group. The longest operative time and aortic occlusion (AO) time were observed in the David group (317,5 [270–375] and 101,5 [92–135–5]), compared with the Yacoub (255 [240–290] and 98,5 [85–118]) and RK (285 [220–345] and 76 [68,5–109]) groups (p = 0,006 and 0,027, respectively). After excluding combined surgeries, the difference was not statistically significant (p = 0,077, p = 0,378). All techniques effectively reduced the fibrous annulus of the AV. In-hospital mortality and the proportion of patients with chronic heart failure ≥ 2 NYHA class were not statistically different between the groups. A higher proportion of patients with AI intermediate-grade were observed in the Yacoub group (21,4 %) compared to the David group (0 %) and the RC group (8,3 %) (p = 0,016).

Conclusion. The David procedure is the procedure of choice for the surgery of AR aneurysm in patients with AI types Ia, Ib, and Ic, and an intact, symmetrical AV. RC is the procedure of choice for asymmetrical AV and AI types Id, II, and III.

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