Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency
<p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Meshalkin National Medical Research Center
2016-08-01
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| Series: | Патология кровообращения и кардиохирургия |
| Subjects: | |
| Online Access: | http://journalmeshalkin.ru/index.php/heartjournal/article/view/343 |
| _version_ | 1797764870955859968 |
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| author | М. Л. Гордеев В. Е. Успенский Г. И. Ким А. Н. Ибрагимов Т. С. Щербинин И. В. Сухова О. Б. Иртюга О. М. Моисеева |
| author_facet | М. Л. Гордеев В. Е. Успенский Г. И. Ким А. Н. Ибрагимов Т. С. Щербинин И. В. Сухова О. Б. Иртюга О. М. Моисеева |
| author_sort | М. Л. Гордеев |
| collection | DOAJ |
| description | <p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br /><strong>Methods:</strong> From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.<br /><strong>Results:</strong> The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.<br /><strong>Conclusions:</strong> Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.</p><div class="well well-small"><strong>Funding</strong></div><p><strong></strong> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies.<br /><strong></strong></p><p><strong>Conflict of interest</strong></p><p><strong></strong>The authors declare no conflict of interest.</p><p><strong>Acknowledgement</strong></p><p>The authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology & Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.</p> |
| first_indexed | 2024-03-12T20:02:00Z |
| format | Article |
| id | doaj.art-8352c2fc6c664a5d8342c6ad96bfae6d |
| institution | Directory Open Access Journal |
| issn | 1681-3472 2500-3119 |
| language | English |
| last_indexed | 2024-03-12T20:02:00Z |
| publishDate | 2016-08-01 |
| publisher | Meshalkin National Medical Research Center |
| record_format | Article |
| series | Патология кровообращения и кардиохирургия |
| spelling | doaj.art-8352c2fc6c664a5d8342c6ad96bfae6d2023-08-02T02:20:16ZengMeshalkin National Medical Research CenterПатология кровообращения и кардиохирургия1681-34722500-31192016-08-01202354310.21688/1681-3472-2016-2-35-431027Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiencyМ. Л. Гордеев0В. Е. Успенский1Г. И. Ким2А. Н. Ибрагимов3Т. С. Щербинин4И. В. Сухова5О. Б. Иртюга6О. М. Моисеева7Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2Северо-Западный федеральный медицинский исследовательский центр им. В.А. Алмазова Министерства здравоохранения Российской Федерации, 197341, Санкт-Петербург, ул. Аккуратова, 2<p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br /><strong>Methods:</strong> From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.<br /><strong>Results:</strong> The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.<br /><strong>Conclusions:</strong> Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.</p><div class="well well-small"><strong>Funding</strong></div><p><strong></strong> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies.<br /><strong></strong></p><p><strong>Conflict of interest</strong></p><p><strong></strong>The authors declare no conflict of interest.</p><p><strong>Acknowledgement</strong></p><p>The authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology & Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.</p>http://journalmeshalkin.ru/index.php/heartjournal/article/view/343Хирургия аортыАортальный клапанКлапаносохраняющие операцииОперация Дэвида |
| spellingShingle | М. Л. Гордеев В. Е. Успенский Г. И. Ким А. Н. Ибрагимов Т. С. Щербинин И. В. Сухова О. Б. Иртюга О. М. Моисеева Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency Патология кровообращения и кардиохирургия Хирургия аорты Аортальный клапан Клапаносохраняющие операции Операция Дэвида |
| title | Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency |
| title_full | Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency |
| title_fullStr | Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency |
| title_full_unstemmed | Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency |
| title_short | Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency |
| title_sort | early results of valve sparing ascending aortic replacement in type a aortic dissection and aortic insufficiency |
| topic | Хирургия аорты Аортальный клапан Клапаносохраняющие операции Операция Дэвида |
| url | http://journalmeshalkin.ru/index.php/heartjournal/article/view/343 |
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