Gordeev M.L., Uspenskij V.E., Kim G.I., Kucherenko V.S., Najmushin A.V., Fokin V.A., Mitrofanova L.B., Moiseeva O.M.
Almazov National Medical Research Centre, Ministry of Health Care of Russian Federation.
153 patients with a diagnosis of type A aortic dissection were operated since January 1, 2006 to December 31, 2016 on the basis of the Almazov National Medical Research Centre, Russia and were included in the study. The patients were divided into two groups: group-1 (81 patients with valve-preserving surgery) and group-2 (72 patients with valve-replacing surgery). An assessment of the initial state of the patients, the state of the valvular apparatus and the ascending aorta, and the indicators of the pathological morphological gradation of aortic wall changes were made. The overall mortality in the intraoperative and early postoperative period was 11.1% (17 people). No valve-associated complications were found. There were no cases of necessity for redo operation with regard to the deterioration of the function of the preserved aortic valve in group-1. According to the histological examination of the aortic wall with acute dissection, there were more pronounced inflammatory changes (p <0.05), and with subacute and chronic dissection the degree of fibrosis was more pronounced, p <0.001. The overall mortality in the late postoperative period was 8.1% (11/136 patients). The cumulative survival rate in group-1 was 80.5% of patients, in group-2 — 67.5%. The survival period in group-1 was longer and amounted to 35 (18; 61) months, compared with 12 (0.72; 50) months in group-2, p <0.05.
In case of aortic dissection type A the supracoronary replacement of ascending aorta with aortic valve repair is an effective and relatively safe technique.
Keywords: aorta, aortic valve, aortic insufficiency, valve-sparing replacement.
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