Features of the perioperative period and assessment of the immediate results of surgical treatment of patients with combined pathology of the outcoming aorta, aortic valve, and coronary artery lesions
DOI:
https://doi.org/10.11603/2414-4533.2026.2.16135Keywords:
ascending aortic aneurysm, ascending aorta wrapping, Robicsek procedure, surgical treatment, ascending aorta bandingAbstract
The aim of the work: to assess the characteristics of the perioperative period and the immediate results of surgical treatment of patients with combined pathology of the ascending aorta, aortic valve, and coronary artery disease.
Materials and Methods. From 2010 to 2024, 78 patients underwent one-stage surgical intervention at the State Institution “Amosov National Scientific Center оf Cardiovascular Surgery and Hereditary Pathology of the National Academy of Medical Sciences of Ukraine», which included aortic valve replacement, ascending aorta banding, and coronary artery bypass grafting. Among the examined patients, men predominated at 83 %, while there were only 13 women (17 %). The average age of patients at the time of surgery was (61.8±9.11) years. The leading diagnostic method for assessing the anatomical and hemodynamic characteristics of the heart was echocardiography.
Results. Hospital mortality was 1.3% (due to acute heart failure). All patients underwent combined intervention: aortic valve replacement, ascending aorta banding, and coronary artery bypass grafting under cardiopulmonary bypass with moderate hypothermia and cardioplegia. According to echocardiography data, hemodynamics improved: a decrease in pressure gradient and ascending aorta diameter (p=0.001), an increase in left ventricular ejection fraction (p<0.05); changes in volumes were not significant. The postoperative course was mostly favorable: 77 % had no complications, the others were managed conservatively. The results confirm the effectiveness and safety of the approach. The results obtained confirm the effectiveness of single-stage surgical treatment in patients with combined pathology of the ascending aorta, aortic valve, and coronary arteries. Combined interventions provide complete correction of hemodynamic disorders according to modern approaches.
Conclusions. One-stage surgical treatment of combined pathology of the ascending aorta, aortic valve, and coronary arteries is an effective and safe method. The combined approach allows for the elimination of all lesions in a single intervention and avoids repeat surgeries. A significant improvement in hemodynamics is observed, in particular, a reduction in pressure gradient, a decrease in aortic diameter, and an increase in ejection fraction. Low hospital mortality confirms the safety of the method.
References
Mack MJ, Leon MB, Thourani VH, et al. Transcatheter Aortic-Valve Replacement in Low-Risk Patients at 5 Years. N Engl J Med. 2023; 389:1949-60. DOI: 10.1056/NEJMoa2307447. Epub. 2023 Oct. 24. DOI: https://doi.org/10.1056/NEJMoa2307447
Thyregod HGH, Ihlemann N, Jørgensen TH, et al. Five-year clinical and echocardiographic outcomes from the NOTION randomized trial. Eur Heart J. 2024; 45(3):210-19.
Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021; 143:e72-e227. DOI: https://doi.org/10.1161/CIR.0000000000000923
Elefteriades JA, Ziganshin BA. Indications and imaging for aortic aneurysm: how to decide. J Thorac Cardiovasc Surg. 2020; 160(2):345-52.
Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019; 40(2):87-165. DOI: https://doi.org/10.1093/eurheartj/ehy855
Chowdhury MM, Angelini GD, Bryan AJ. Outcomes of combined aortic valve replacement and coronary artery bypass grafting. J Card Surg. 2022; 37(5):1201-08.
Salna M, Girardi LN, Gaudino M, et al. Outcomes of concomitant ascending aortic replacement with cardiac surgery. Ann Thorac Surg. 2024; 117(2):456-63.
Biancari F, Mariscalco G, Dalén M, et al. Meta-analysis of complications after combined cardiac procedures. Heart. 2021; 107(16):1325-32.
Preventza O, Coselli JS, Price MD, et al. Elective ascending aorta replacement: outcomes and risk factors. J Thorac Cardiovasc Surg. 2020; 159(6):2170-79.
Wu BC, Harloff M, Girardi LN, et al. Concomitant coronary artery bypass grafting and aortic surgery: early outcomes. Ann Thorac Surg. 2025; 119(1):112-18.
Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation. 2014; 129(23):e521-e643. DOI: https://doi.org/10.1161/CIR.0000000000000031
Girdauskas E, Disha K, Borger MA, et al. Concomitant ascending aortic replacement does not increase operative risk. Eur J Cardiothorac Surg. 2012; 42(5):832-38. DOI: https://doi.org/10.1093/ejcts/ezs137
Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of thoracic aortic surgery with extended cross-clamp and bypass times. Ann Thorac Surg. 2016; 102(3):748-55.
Brown ML, Schaff HV, Sarano ME, et al. Is concomitant ascending aortic replacement safe? J Thorac Cardiovasc Surg. 2009; 137(5):1069-74.
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014; 35(41):2873-926. DOI: https://doi.org/10.1093/eurheartj/ehu281
Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of thoracic aortic surgery with extended cross-clamp and bypass times. Ann Thorac Surg. 2016; 102(3):748-55.
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