Aortic Valve Neocuspidization as the Base for Aortic Root Reconstruction Surgery

Roman Komarov, Andrey Katkov, Maxim Tcheglov

Sechenov First Moscow State Medical University, Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: The purpose of this study was to evaluate the effectiveness and feasibility of aortic valve neocuspidization - Ozaki procedure (AVNeo) and to compare hemodynamic efficiency with conventional methods aortic valve replacement (AVR), and also the possibility of using the AVNeo as the base for reconstructions of various types of pathology of  aortic root . Materials and methods: The study population consisted of three groups of patients with aortic valve surgeries performed between January 2016 and November 2017. Group I (n=33) underwent AVNeo, Group II (n=46) - AVR by mechanical prostheses, and Group III (n=36) - AVR by stented bioprostheses. The aortic valve annulus measured 21±1.5mm, 20.7±1.2 mm and 20.8±1.1 mm for Group I, II and III respectively. In that same order, the mean valve gradients were 58.4±12.2 mmHg, 45.3±8.2 mmHg and 45.3±7.2 mmHg. In the first group 3 patients had aortic valve insufficiency stages II-III, ascending aortic dilatation > 5 cm, and AVNeo had combined with aortic root reconstruction by T.David's method. Hemodynamic and time parameters of operation were compared. Results: Echocardiography parameters after operation: I - mean valve gradient (MVG) 10.6±3.2mmHg; II - MVG 13.7±0.7 mmHg; III - MVG 17.46±0.8 mmHg. Time parameters: in the order Group I, II, III the recorded times of operation (in minutes) were 264±20.4, 248±24.4 and 290±19.4. In that same chronology, the CPB times (in minutes) were: 126.7±24.8, 103.7±23.4 and 119±22.2, and finally the aortic cross-clamp time (in minutes) were: 104.8±20.5, 81.9±18.5 and 87.6±19.5. Conclusion: According to echocardiography data, AVNeo procedure was found to be associated with better hemodynamic and acceptable time parameters than AVR operation. Moreover, combination of AVNeo and T. David procedure is the better option for surgery of aortic root dilatation versus operation of Bentall de Bono and (like combination of AVNeo + Yacoub technique).