Vol. 19 No. 4 (2015)
CORONARY ARTERY DISEASES

Results of aortic root reimplantation in patients with ascending aortic aneurysm and concomitant aortic insufficiency

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  • A. Chernyavskii,
  • D. Khvan,
  • S. Al'sov,
  • D. Sirota,
  • M. Lyashenko
A. Chernyavskii
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
D. Khvan
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
S. Al'sov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
D. Sirota
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
M. Lyashenko
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2015-4-38-47

Published 2016-01-11

Keywords

  • aorta,
  • aortic insufficiency,
  • valve-sparing operation

How to Cite

Chernyavskii, A., Khvan, D., Al’sov, S., Sirota, D., & Lyashenko, M. (2016). Results of aortic root reimplantation in patients with ascending aortic aneurysm and concomitant aortic insufficiency. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 19(4), 38–47. https://doi.org/10.21688/1681-3472-2015-4-38-47

Copyright (c) 2016 Chernyavskii A.M., Khvan D.S., Al'sov S.A., Sirota D.A., Lyashenko M.M.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

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.

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