Результаты реимплантации корня аорты в протез у пациентов с аневризмой восходящего отдела аорты и недостаточностью аортального клапана

Abstract

Objective. The research was designed to evaluate the results of valve-sparing operations: aortic root reimplantation versus aortic valve reimplantation when repairing an ascending aortic aneurysm with concomitant aortic insufficiency. Methods. Within a blind prospective randomized study conducted over a period from 2011 to 2015, 64 patients underwent aortic valve-sparing surgery. The inclusion criteria were the presence of an aortic aneurysm of the ascending aorta exceeding 4.5 cm and concomitant aortic insufficiency. All patients were divided into two groups: FS-group, aortic root reimplantation (modified Florida Sleeve technique) (n = 32) and D-group, aortic valve reimplantation (David procedure) (n = 32). The average age of patients was 57±13 (23–73) years in the FS-group and 55±11 (15–72) years in the D-group (p = 0.54). Both groups had 78% of males (p>0.99). A Marfan syndrome was identified in 6% and 9% in the FS-group and D-group respectively (p>0.99). Mean diameter of the sinuses of Valsalva was 51±7 mm and 56±10 mm (p = 0.09), aortic insufficiency 2.6±0.7 and 2.8±0.8 (p = 0.15) in the FS-group and D-group respectively. In the FS-group and D-group LVEDD amounted to 5.5±0.7 mm and 5.9±1.0 mm (p = 0.09) respectively. All patients took echocardiography in the preoperative, postoperative and follow-up periods. Results. In the long-term period, the degree of aortic regurgitation was 1.2±0.1 in the FS-group and 1.3±0.6 in the D-group (p = 0.72). LVEDD was 123±23 mm in the FS-group and 139.6±80 mm in the D-group at follow-up (p = 0.77). There were no statistically significant differences in the analysis of complications. Overall 30-day in-hospital mortality was 7.8%. There were 2 (6.3%) deaths in the FS-group and 3 (9.4%) in the D-group (p = 0.5). Late mortality was 6.3% in the FS-group and 3.1% in the D-group (p>0.99). Cumulative survival at 4 years was 84.3% and 84.8% in the FS-group and the D-group respectively (p = 0.94). Cumulative freedom from aortic insufficiency more than 2+ at 4 years was 88.9% and 87.7% in the FS-group and the D-group respectively (p = 0.88). Conclusions. Aortic root reimplantation allows to simplify and speed up this valve-sparing technique in patients suffering from aortic root aneurism with concomitant aortic insufficiency and demonstrates good early clinical results comparable to the conventional aortic valve reimplantation procedure.