Exravalvular exoprosthetic repair of the aortic root: first experience

Chernyavsky A.M., Alsov S.A., Khvan D.S., Sirota D.A., Lyashenko M.M.

Centre for Surgery of the Aorta and Coronary Artery, Coronary and Peripheral Arteries, Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin, Novosibirsk, Russia

Introduction. Understanding the processes underlying the development of arterial insufficiency in pathology of the ascending portion of the aorta, structure and function of the aortic root became the basis for the appearance and implementation of the technique of extravalvular exoprosthetic repair of the aortic root (the Florida sleeve technique) – a new approach to valve saving procedures on the aortic root.

Patients and methods. Seven patients presenting with an aneurysm of the ascending portion of the aorta and concomitant moderate-to-pronounced portal insufficiency underwent open extravalvular exoprosthetics of the aortic root according to the Florida sleeve technique. The patients’ average age was 50±21.41 (range 23–71) years. Of these, four were males (57%). The accompanying diseases revealed were as follows: aortic dissection in 3 cases (2 cases with DeBackey type I and 1 case with – DeBackey type II), Marfan syndrome – 2. One patient was found to have developmental abnormality as Arteria Lusoria. Functional class of heart failure according to the NYHA classification averagely amounted to 2.3. Degree 3 arterial hypertension was revealed in three cases.

Results. In the postoperative period the degree of aortic insufficiency decreased from the average preoperative value by the group 2.42±0.53 (prior to operation) and amounted to 0.92±0.73 (p=0.03) after surgery. Also noted was reverse remodelling of the left ventricle: a decrease in the EDV from 142.8±47.0 ml before the operation to 133.1±55.89 ml (p=0.46) thereafter. There were no cases of re-do operations for aortic insufficiency within the 30-day follow up period, with one lethal outcome during 30 days.

Discussion. The operation of exoprosthetics of the aortic root demonstrated satisfactory immediate results, however there is no doubt that proper analysis of the immediate and remote outcomes would require a larger number of cases. This would make it possible to determine the feasibility and the place of this technique in surgical decision-making while treating aneurysms of the ascending portion of the aorta with accompanying aortic insufficiency and to extend the spectrum of surgical interventions in the pathology concerned.

KEY WORDS: aneurysm of the thoracic portion of the aorta, insufficiency of the aortic valve, valve-saving operation, extravalvular exoprosthetics of the aortic root.

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