Comparative aspects of surgical treatment of the patients with thoracic aorta diseases

Сравнительные аспекты хирургического лечения пациентов с заболеваниями грудного отдела аорты
Vladimir Dikolayev 1 2 * , Adilzhan Albazarov 2, Turlybek Tuganbekov 1 2, Vladimir Grigorevsky 1, Kulsara Rustemova 1, Saule Nurakaeva 2, Murat Raikhanov 3
More Detail
1 Department of Surgical Diseases, Astana Medical University, Nur-Sultan city, Republic of Kazakhstan
2 Cardiac Surgery Department, National Scientific Medical Research Center, Nur-Sultan city, Republic of Kazakhstan
3 Cardiac Surgery Department, Regional Cardiac Center», Pavlodar city, Republic of Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 2, Issue 52, pp. 42-49. https://doi.org/10.23950/1812-2892-JCMK-00686
OPEN ACCESS 2972 Views 2797 Downloads
Download Full Text (PDF)

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).

CITATION

Dikolayev V, Albazarov A, Tuganbekov T, Grigorevsky V, Rustemova K, Nurakaeva S, et al. Comparative aspects of surgical treatment of the patients with thoracic aorta diseases. Journal of Clinical Medicine of Kazakhstan. 2019;2(52):42-9. https://doi.org/10.23950/1812-2892-JCMK-00686

REFERENCES

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