Chirurgická léčba aneuryzmatu aortálního kořene: srovnání Bentallovy operace a reimplantace aortální chlopně podle Davida

Abstract

The aortic root aneurysm is associated with a more frequent occurrence of aortic dissection and development of aortic regurgitation. The aim of this study was to compare outcomes of composite graft replacement and valve sparing root replacement in treating aortic root aneurysms.From January 2006 to December 2015 a total of 137 patients (mean age 46.3 ± 14.5, range 16-65) underwent elective surgery for aortic root aneurysm without valvular structural defects. Replacement by mechanical composite graft (Bentall procedure) has been performed in 46 patients while 91 patients underwent valve sparing root replacement (David procedure). The mean length of follow-up has been 77 months.There was no operative death. Overall 9 patients died during follow-up. Five patients were after Bentall procedure and 4 were after reimplantation of aortic valve. Thromboembolic and bleeding complications were observed in 7 patients, 5 of them were after Bentall surgery and 2 after reimplantation of the aortic valve. Five patients after reimplantation of aortic valve underwent reoperation. Four of these patients had aortic valve replacement and in 1 case aortic homograft was implanted.Bentall procedure used to be the standard treatment for patients with aortic root aneurysms. During the past two decades, aortic valve sparing procedure has gained widespread use to reduce thromboembolic and bleeding complications.Key words: aortic root aneurysm - composite graft replacement - valve-sparing root replacement.