[Aortic root surgery: early postoperative results of different surgical techniques]. / Aortos saknies operacijos: skirtingu operaciniu metodiku ankstyvieji rezultatai.

UNLABELLED: The aim of the study was to evaluate early postoperative results of different surgical techniques of aortic root surgery. MATERIAL AND METHODS: Between January 2004 and November 2007, a cohort of 83 patients underwent aortic root surgery in the Heart Center, Hospital of Kaunas University of Medicine. Patients were divided into three groups: Group 1 (18 patients) - reimplantation of the aortic valve within a vascular graft (David operation), Group 2 (48 patients) - replacement of the ascending aorta and aortic valve using a valved conduit (Bentall de Bono operation), and Group 3 (17 patients) - biological aortic root replacement. Study protocol included clinical data, operative data, and postoperative major adverse effects: reoperations for bleeding, stroke and lethal outcomes. RESULTS: Patients undergoing biological aortic root replacement were older as compared with other groups. The mean age in the Group 1 was 50.3+/-3.5 years vs. 57+/-2.0 years in the Group 2 and 67.8+/-3.3 years in the Group 3 (P<0.05). The main indication for the aortic root surgery was the aneurysm of the aortic root and ascending aorta in the Group 1 and 2 patients (64.7% and 72%), while in the Group 3, the main indication was fibrocalcinosis of aortic valve, aortic annulus, and ascending aorta (61.1%). The 30-day hospital mortality rates were as follows: 5.8% (n=1), in the Group 1; 10.4% (n=5), in the Group 2; 5.5% (n=1), in the Group 3. In the early postoperative period, 11 reoperations were performed due to bleeding events: in the Group 1, after planned/emergency surgery (n=2/2), and in the Group 2 (n=1/6), respectively. The function of aortic valve improved significantly in all groups of patients early after surgery. In the Group 1, the degree of aortic regurgitation decreased from 2.5+/-0.8 to 1.1+/-0.6 (P<0.05); in the Groups 2 and 3, the mean gradient through the aortic valve decreased from 39.9+/-7.5 to 17.1+/-5.3 mm Hg and from 48.8+/-18.0 to 20.1+/-11.0 mm Hg, respectively (P<0.05). No reoperation for aortic valve failure before the discharge was required in all groups of patients, and neither thromboembolic complications nor stroke events were noted in any group. CONCLUSIONS: Different aortic root surgery techniques showed similar postoperative results. New aortic root surgery methods such as aortic root-preserving/sparing procedures and concurrent aortic valve leaflet repair or aortic root replacement with the bioprosthesis can be selected for a diverse class of aortic root pathology with low perioperative mortality rates and good early postoperative results.

[Early and late postoperative results after stentless aortic bioprosthesis implantation: experience of Heart Center, Kaunas University of Medicine]. / Bestentiniu aortos voztuvu implantacijos ankstyvieji ir velyvieji pooperaciniai rezultatai (Kauno medicinos universiteto Sirdies centro duomenys).

UNLABELLED: The aim of our study was to evaluate the impact of stentless aortic bioprosthesis implantation on early and late postoperative results and hemodynamic changes. MATERIAL AND METHODS: Study group consisted of 66 patients, who received stentless aortic bioprosthesis in 1999-2003, and control group of 38 patients, randomly selected for data analysis out of 203 patients, who received mechanical aortic valve substitute during the same period at the Heart Center of Kaunas University of Medicine. Study protocol included clinical data, patients functional status and echocardiographic data pre and postoperatively up to 2 years. RESULTS: Within a stentless bioprosthesis group clinically more severe forms of aortic valve disease were present (NYHA f. cl. 3.47 vs 3.0), with concomitant ischemic heart disease (51.5% vs 36.8%), and mitral valve insufficiency (51.5% vs 21.1%). Subsequently coronary artery bypass grafting was performed in 50% of patients within a stentless bioprosthesis group vs 28.9% in a mechanical valve group, and mitral valve repair in 30.49% vs 10.5%. Aortic cross clamp time in a stentless bioprosthesis group was 89.1+/-21.3 min, compared to 74.6+/-39.5 min in a "mechanical" group. Data analysis of valve/body surface area match was in favor of stentless valves: patients with the same body surface area received one size larger stentless valves. Mortality in a "stentless" group was 4.54 vs 7.3% in mechanical group. Mean transvalvular gradients after 2 years were statistically significantly lower in a "stentless" group: 9.4+/-3.1 mmHg vs 11.1+/-4.1 mmHg. Also there was significant decrease of left ventricular mass and mass index in both groups, however it was more pronounced in the "stentless" valve group. CONCLUSIONS: Despite more advanced patient age, stages of aortic valve disease, complexity of operations including more demanding stentless bioprosthesis implantation techniques, early and late postoperative results are in favor of stentless bioprosthesis. Low and acceptable postoperative mortality, lower transvalvular gradients, optimal matching of valve and body surface area, could be achieved, which warrants more pronounced positive postoperative left ventricular remodeling: reduction of left ventricle mass and left ventricle mass index with improved pts survival.