Original method of posterior aortoplasty for aortic valve replacement in surgical treatment of combined mitral-aortic valve diseases

Abstract

Objective. To research of possibilities of reconstruction of aorta`s ostium and ascending aorta during aortic valve replacement and simultaneous correction of mitral valve defects at patients with narrow aorta`s ostium. Materials and methods. The study group consisted of 46 patients with mitral-aortic heart diseases and combination with a narrow aortic mouth, who were operated on at the A Amosov National Institute of Cardiovascular surgery for the period from January 1, 2006 to January 1, 2020. All patients underwent reconstruction of the aortic root and ascending aorta according to the original method of posterior aortoplasty. There were 26 men (56.5%) and 20 women (43.5%). The age of patients ranged from 23 to 72 years (average - 58.4±7.3 years). 8 (17.4%) patients belonged to class III NYHA, 38 (82.6%) - to class IV. Results. Of the 46 operated patients at the hospital stage (30 days after surgery), 4 died (hospital mortality 8.7%). No fatalities were associated with surgical technique. The dynamics of echocardiographic parameters at the hospital stage was as follows: the systolic gradient on the aortic valve was before surgery 112.1 ± 15.2 mm Hg, on the aortic prosthesis at discharge - 23.2 ± 6.4 mm Hg; end-systolic index (ESI) of the left ventricle (ml/m²) - 59.1 ± 7.6 (before surgery) and 48.3 ± 5.9 (after surgery); left ventricle ejection fraction (EF) - 0.45 ± 0.04 (before surgery) and 0.53 ± 0.04 (after surgery). Conclusions. The proposed original technique of posterior aortoplasty allows to effectively expand the mouth of the aorta for further implantation of an artificial heart valve of larger diameter. The technique is quite safe. At the hospital stage there are no complications directly related to the technique of operations. At the early postoperative period, the morphometric parameters of the left ventricle (EF and ESI) improved. The technique can be successfully used for the correction of combined mitral-aortic valve defects.

Keywords

• narrow aorta`s ostium, plasty of ostium, aortic valve replacement, cardiopulmonary bypass, combined mitral-aortic valve diseases.