Vol. 21 No. 1 (2017)
ENDOVASCULAR SURGERY: SPECIAL TOPIC

Choosing the best myocardial revascularization method when performing Ross procedure in patients with aortic diseases and coronary artery disease

PDF (Русский)
  • D. Zubarev,
  • E. Kretov,
  • I. Demin,
  • R. Naydenov,
  • A. Prohorihin,
  • V. Baystrukov,
  • E. Pokushalov,
  • A. Karaskov
D. Zubarev
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
Bio
E. Kretov
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
I. Demin
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
R. Naydenov
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
A. Prohorihin
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
V. Baystrukov
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
E. Pokushalov
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
A. Karaskov
Meshalkin Siberian Federal Biomedical Research Center, Ministry of Health of Russian Federation, 630055 Novosibirsk, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2017-1-14-23

Published 2017-04-25

Keywords

  • coronary angioplasty,
  • Ross procedure,
  • coronary artery bypass graft surgery

How to Cite

Zubarev, D., Kretov, E., Demin, I., Naydenov, R., Prohorihin, A., Baystrukov, V., Pokushalov, E., & Karaskov, A. (2017). Choosing the best myocardial revascularization method when performing Ross procedure in patients with aortic diseases and coronary artery disease. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 21(1), 14–23. https://doi.org/10.21688/1681-3472-2017-1-14-23

Copyright (c) 2017 Zubarev D.D., Kretov E.I., Demin I.I., Naydenov R.A., Prohorihin A.A., Baystrukov V.I., Pokushalov E.A., Karaskov A.M.

Creative Commons License

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

Abstract

Aim. The article compares long-term outcomes after Ross procedure in patients with combined coronary arteries lesion depending on a myocardial revascularization technique: coronary angioplasty or coronary artery bypass graft surgery (CABG).
Methods. This prospective randomized one-center trial included 105 patients with aortic valve stenosis and combined arteriosclerotic involvement of coronary arteries. All patients received Ross procedure and myocardial revascularization. Aortic valve stenosis combined with hemodynamically significant lesion of the coronary bed served as the criteria of entry in the trial. A comparative analysis of the results in the immediate postoperative period and during 1-year follow-up was carried out.
Results. The study revealed statistically significant differences in the survival rate (p = 0.024). In the CABG + Ross procedure group, the 1-year survival rate was 77 % [66; 89], which was considerably lower than that in the group with transluminal coronary angioplasty and Ross procedure – 92 % [85; 99]. Mortality in the groups under study predominantly occurred during the 1st postoperative month. In the CABG + Ross procedure group mortality was mostly recorded during the intervention and at 13th postoperative day. In the group with transluminal coronary angioplasty and Ross procedure fatal cases tended to happen at the 6th to 18th day after the intervention.
Conclusion. The study was the first to show the advantage of 1-year lethality results in the percutaneous transluminal coronary angioplasty + Ross procedure group as compared to the CABG + Ross procedure group. Nevertheless, it should be noted that one-stage aortic stenosis repair and CABG is a conventional option. In this case, a multimodality approach could be recommended for taking an optimal decision.

Received 1 March 2017. Accepted 31 March 2017.

Financing: The study did not have sponsorship.
Conflict of interest: Kretov E.I. served as executive editor of “Endovascular surgery” section. All other authors declare no conflict of interest.
Author contributions
Data collection and analysis: Zubarev D.D., Demin I.I., Naydenov R.A., Prohorihin A.A., Baystrukov V.I.
Critical revision: Kretov E.I., Pokushalov E.A., Karaskov A.M.

PDF (Русский)

References

  1. Зубарев Д.Д., Кретов Е.И., Хелимский Д.А., Найденов Р.А., Бирюков А.В., Прохорихин А.А., Покушалов Е.А., Караськов А.М. Результаты одномоментного вмешательства у пациентов с сочетанным поражением коронарных артерий и стенозом аортального клапана. Патология кровообращения и кардиохирургия. 2016;20(3):31-41. http://dx.doi.org/10.21688/1681-3472-2016-3-31-41 [Zubarev D.D., Kretov E.I., Khelimskiy D.A., Naydenov R.A., Biryukov A.V., Prokhorikhin A.A., Pokushalov E.A., Karaskov A.M. Results of simultaneous intervention in patients with concomitant coronary artery disease and aortic stenosis. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2016;20(3):31-41. (In Russ.) http://dx.doi.org/10.21688/1681-3472-2016-3-31-41]
  2. Чернов И.И., Козьмин Д.Ю., Уртаев Р.А., Тунгусов Д.С., Макеев С.А., Демецкая В.В., Козлова К.А., Тарасов Д.Г. Результаты операции Росса у больных с пороками аортального клапана. Кардиология и сердечно-сосудистая хирургия. 2013;(1):72-5. [Chernov I.I., Koz'min D.Iu., Urtaev R.A., Tungusov D.S., Makeev S.A., Demetskaia V.V., Kozlova K.A., Tarasov D.G. Results of Ross operation in patients with aortic valve diseases. Kardiologiya i serdechno-sosudistaya khirurgiya = Cardiology and Cardiovascular Surgery. 2013;(1):72-5. (In Russ.)]
  3. Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P., Guyton R.A., O'Gara P.T., Ruiz C.E., Skubas N.J., Sorajja P., Sundt T.M. 3rd, Thomas J.D.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2014; 63(22):e57-185. http://dx.doi.org/10.1016/j.jacc.2014.02.536
  4. Karaskov A., Sharifulin R., Zheleznev S., Demin I., Lenko E., Bogachev-Prokophiev A. Results of the Ross procedure in adults: a single-centre experience of 741 operations. Eur J Cardiothorac Surg. 2016;49(5):e97-e104. http://dx.doi.org/10.1093/ejcts/ezw047
  5. Czer L.S., Goland S., Soukiasian H.J., Gallagher S., De Robertis M.A., Mirocha J., Siegel R.J., Kass R.M., Trento A. Aortic valve replacement or heart transplantation in patients with aortic stenosis and severe left ventricular dysfunction. Transplant Proc. 2013;45(1):364-8. http://dx.doi.org/10.1016/j.transproceed.2012.04.032.
  6. Connolly H.M., Oh J.K., Orszulak T.A., Osborn S.L., Roger V.L., Hodge D.O., Bailey K.R., Seward J.B., Tajik A.J. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation. 1997;95(10):2395-400.
  7. Lytle B.W., Cosgrove D.M., Goormastic M., Loop F.D. Aortic valve replacement and coronary bypass grafting for patients with aortic stenosis and coronary artery disease: early and late results. Eur Heart J. 1988;9 Suppl E:143-7.
  8. Hannan E.L., Wu C., Bennett E.V., Carlson R.E., Culliford A.T., Gold J.P., Higgins R.S., Smith C.R., Jones R.H. Risk index for predicting in-hospital mortality for cardiac valve surgery. Ann Thorac Surg. 2007;83(3):921-9.
  9. Nowicki E.R., Birkmeyer N.J., Weintraub R.W., Leavitt B.J., Sanders J.H., Dacey L.J., Clough R.A., Quinn R.D., Charlesworth D.C., Sisto D.A., Uhlig P.N., Olmstead E.M., O'Connor G.T.; Northern New England Cardiovascular Disease Study Group and the Center for Evaluative Clinical Sciences, Dartmouth Medical School. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in northern New England. Ann Thorac Surg. 2004;77(6):1966-77.
  10. Kuduvalli M., Grayson A.D., Au J., Grotte G., Bridgewater B., Fabri B.M. A multi-centre additive and logistic risk model for in-hospital mortality following aortic valve replacement. Eur J Cardiothorac Surg. 2007;31(4):607-13. http://dx.doi.org/10.1016/j.ejcts.2006.12.035
  11. Lund O., Nielsen T.T., Pilegaard H.K., Magnussen K., Knudsen M.A. The influence of coronary artery disease and bypass grafting on early and late survival after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg. 1990;100(3):327-37.
  12. Mullany C.J., Elveback L.R., Frye R.L., Pluth J.R., Edwards W.D., Orszulak T.A., Nassef L.A. Jr., Riner R.E., Danielson G.K. Coronary artery disease and its management: influence on survival in patients undergoing aortic valve replacement. J Am Coll Cardiol. 1987;10(1):66-72.
  13. Jones J.M., Lovell D., Cran G.W., MacGowan S.W. Impact of coronary artery bypass grafting on survival after aortic valve replacement. Interact CardioVasc Thorac Surg. 2006;5(3):327-30. http://dx.doi.org/10.1510/icvts.2005.118349
  14. Chikwe J., Croft L.B., Goldstone A.B., Castillo J.G., Rahmanian P.B., Adams D.H., Filsoufi F. Comparison of the results of aortic valve replacement with or without concomitant coronary artery bypass grafting in patients with left ventricular ejection fraction <= 30% versus patients with ejection fraction >30%. Am J Cardiol. 2009;104(12):1717-21. http://dx.doi.org/10.1016/j. amjcard.2009.07.059
  15. Rankin J.S., Hammill B.G., Ferguson Jr. T.B., Glower D.D., O'Brien S.M., DeLong E.R., Peterson E.D., Edwards F.H. Determinants of operative mortality in valvular heart surgery. J Thoracic Cardiovasc Surgery. 2006;131(13):547-57. http://dx.doi.org/10.1016/j.jtcvs.2005.10.041
  16. Byrne J.G., Leacche M., Unic D., Rawn J.D., Simon D.I., Rogers C.D., Cohn L.H. Staged initial percutaneous coronary intervention followed by valve surgery (‘hybrid approach’) for patients with complex coronary and valve disease. J Am Coll Cardiol. 2005;45(1):14-8. http://dx.doi.org/10.1016/j.jacc.2004.09.050
  17. Brinster D.R., Byrne M., Rogers C.D., Baim D.S., Simon D.I., Couper G.S., Cohn L.H. Effectiveness of same day percutaneous coronary intervention followed by minimally in- vasive aortic valve replacement for aortic stenosis and moderate coronary disease (‘hybrid approach’). Am J Cardiol. 2006;98(11):1501-3. http://dx.doi.org/10.1016/j.amjcard.2006.08.010