Online ISSN 2313-1519
Print    ISSN 1812-2892
Abstract - Comparative aspects of surgical treatment of the patients with thoracic aorta diseases
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Vladimir Dikolayev, Adilzhan Albazarov, Turlybek Tuganbekov, Vladimir Grigorevsky, Kulsara Rustemova, Saule Nurakaeva, Murat Raikhanov

ABSTRACT

Objective: To carry out comparative analysis of the various surgical methods in patients with thoracic aorta pathology (aneurism, dilatation, dissection) in combination with bicuspid aortic valve in comparison to tricuspid aortic valve patients and to choose most appropriate approach of the surgical treatment in correlation with thoracic aorta sizes.

Material and methods: In this work 212 case records of two patient groups with thoracic aorta pathology were analyzed, operated from 2013 until 2015 in cardiothoracic department of the “National Scientific Medical Center” JSC, to whom 4 surgical approaches were applied: Bentall de Bona procedure, supracoronary aorta replacement  procedure, David procedure, Borst procedure.  

Results: Usage of  Bentall de Bona procedure in patients with  bicuspid aortic valve was related to less risk of postoperative complications in comparison with the group of tricuspid aortic valve patients (17,5% vs 39,5%, p=0,01). Surgical treatment with the usage of David procedure in observation group with BAV eliminates aortic valve insufficiency (degree of aortic valve insufficiency pre and postoperative - 2,3 ± 1,3 and 0,9 ± 1,1 respectively, p=0,04).

Conclusion: Surgical treatment of thoracic aorta pathology in patients with bicuspid aortic valve (mainly with stenosis) with the usage of Bentall de Bona approach is accepted as reasonable because it eliminates most considerably the implications of aortopathy and in this regard considered to be the most effective. David procedure is indicated to patients with pathology of thoracic aorta in combination with bicuspid aortic valve (mainly with insufficiency).

Key words: bicuspid aortic valve, thoracic aneurysm, Bentall de Bona procedure, David procedure

Corresponding Author: Vladimir Dikolayev, Cardiac Surgery Department, National Scientific Medical Center. Address: 43/1, Pobeda Street, ap. 1, 010000, Nur-Sultan, Republic of Kazakhstan. Tel.: 7 (717)2 38-50-61, mob.: +77752249806. E-mail: dikolayevv@mail.ru

 

References

1. Belokon N.A., Pozolkov V.P. Vrozhdennye poroki serdtsa (Congenital heart defects) [in Russian]. Medicine. 1991; 352.

2. Mills P., Leech G., Davies M., et al. The natural history of a non-stenotic bicuspid aortic valve. Br Heart J. 1978; 40:951-957. https://doi.org/10.1136/hrt.40.9.951

3. Fenoglio, J.J., McAllister, H.A., DeCastro, C.M., Davia, J.E., Cheitlin, M.D. Congenital bicuspid aortic valve after age 20. American Journal of Cardiology. 1977; 39:164-169.
https://doi.org/10.1016/S0002-9149(77)80186-0

4. Vallely MP, Semsarian C, Bannon PG. Management of the ascending aorta in patients with bicuspid aortic valve disease. HeartLungCirc. 2008; 17:357-63. https://doi.org/10.1016/j.hlc.2008.01.007

5. Yasuda H, Nakatani S, Stugaard M, et al. Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: Comparison with tricuspid aortic valve. Circulation. 2003; 108(l1):II291- 4. https://doi.org/10.1161/01.cir.0000087449.03964.fb

6. Russo CF, Mazzetti S, Garatti A, et al. Aortic complications after bicuspid aortic valve replacement: Long-term results. AnnThoracSurg. 2002; 74:S1773- 6; discussion S1792-9.
https://doi.org/10.1016/S0003-4975(02)04261-3

7. Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J ThoracCardiovascSurg. 2004; 128:677-83.
https://doi.org/10.1016/j.jtcvs.2004.07.009

8. Fazel SS, Mallidi HR, Lee RS, et al. The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J ThoracCardiovascSurg. 2008; 135:901-7, 907.e1-2. https://doi.org/10.1016/j.jtcvs.2008.01.022

9. Westhoff-Bleck M, Meyer GP, Lotz J, et al. Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: A magnetic resonance angiography study. Vasa. 2005; 34:181-5.
https://doi.org/10.1024/0301-1526.34.3.181

10. Guntheroth WG, Spiers PS. Does aortic root dilatation with bicuspid aortic valves occur as a primary tissue abnormality or as a relatively benign poststenotic phenomenon? Am J Cardiol. 2005; 95:820.
https://doi.org/10.1016/j.amjcard.2004.12.004

11. Etz CD, Homann TM, Silovitz D, et al. Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve. AnnThoracSurg. 2007; 84:1186-93; discussion 1193-4.
https://doi.org/10.1016/j.athoracsur.2007.03.057

12. Houel R, Soustelle C, Kirsch M, Hillion ML, Renaut C, Loisance DY. Long-term results of the bentall operation versus separate replacement of the ascending aorta and aortic valve. J HeartValveDis. 2002; 11:485-91.

13. Hagl C, Strauch JT, Spielvogel D, et al. Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival? AnnThoracSurg. 2003; 76:698-703; discussion 703. https://doi.org/10.1016/S0003-4975(03)00568-X

 

Volume 2, Number 52 (2019)