Д. А. Божко, Ю. М. Чеснов, С. В. Спиридонов, С. А. Курганович
ГУ РНПЦ «Кардиология», г. Минск
Выполнен анализ ранних результатов лечения 255 пациентов с расширением восходящей аорты от 40 до 55 мм в диаметре и патологией аортального клапана. 93 пациентам выполнено протезирование аортального клапана и экзопротезирование восходящей аорты, 107 пациентам выполнено протезирование аортального клапана и восходящей аорты, 55 пациентам – изолированное протезирование аортального клапана. При выполнении экзопротезирования по сравнению с протезированием восходящей аорты отмечены меньшее время ишемии миокарда и искусственного кровообращения, меньшая частота послеоперационных кровотечений и рестернотомий. Экзопротезирование восходящей аорты помимо укрепления стенки восходящей аорты приводило к уменьшению ее среднего диаметра с 45,47 ± 2,96 мм до 36,25 ± 4,08 мм. Не выявлено специфических осложнений метода экзопротезирования, таких как дислокация экзопротеза, кинкинг, редилатация, диссекция аорты. Метод экзопротезирования показал низкий уровень кардиоваскулярных осложнений и госпитальной летальности.
ключевые слова: восходящая аорта, аневризма, расширение аорты, экзопротезирование, наружная аортопластика
Early results of surgical treatment of patients with ascending aorta dilatation and aortic valve diseases
D. А. Bozhko, Y. M. Chesnov, S. V. Spiridonov, S. A. Kurganovich
The analysis of early treatment results in 255 patients with ascending aorta dilatation from 40 to 55 mm in diameter and aortic valve diseases was performed. 93 patients underwent aortic valve replacement and wrapping of the ascending aorta, 107 patients underwent aortic valve and ascending aorta replacement, 55 patients underwent isolated aortic valve replacement. When performed wrapping, compared with ascending aorta replacement, there was a shorter time of myocardial ischemia and cardiopulmonary bypass, a lower incidence of postoperative bleeding and resternotomy. Ascending aorta wrapping, in addition to reinforcement of the ascending aorta wall, led to a decrease in its average diameter from 45.47 ± 2.96 mm to 36.25 ± 4.08 mm. There were no specific complications of the wrapping method, such as wrap dislocation, kinking, redilatation, aortic dissection. The wrapping method showed a low level of cardiovascular complications and hospital mortality.
keywords: ascending aorta, aneurism, aorta dilatation, wrapping, external aortoplastic
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2. Aortic Wrapping for a Dilated Ascending Aorta in Bicuspid Aortic Stenosis / M. S. Choi [et al.] // Circulation. – 2015. – Vol. 79. – P. 778–784.
3. ESC (2014) Guidelines on the diagnosis and treatment of aortic diseases / Europ. Heart J. – 2014. – Vol. 35. – P. 2873–2926.
4. Plonek, T. A metaanalysis and systematic review of wrapping of the ascending aorta. / T. Plonek // J. Card. Surg. – 2014. – Vol. 29, № 6. – P. 809–815. doi:10.1111/jocs.12448.
5. Short-term outcomes of aortic wrapping for mild to moderate ascending aorta dilatation in patients undergoing cardiac surgery / J. Y. Park [et al.] // Korean J. Thorac. Cardiovasc. Surg. – 2012. – Vol. 45, № 3. – P. 148–154. doi:10.5090/kjtcs.2012.45.3.148.
6. Long-term experience of girdling the ascending aorta with Dacron mesh as definitive treatment for aneurysmal dilation / O. Cohen [et al.] // Ann Thorac Surg. – 2007. – Vol. 83, № 2. – P. 780–784. doi:10.1016/j.athoracsur.2006.10.086.
7. Management of dilated ascending aorta during aortic valve replacement: valve replacement alone versus aorta wrapping versus aorta replacement / S. H. Lee [et al.] //J. Thorac. Cardiovasc. Surg. – 2013. – Vol. 146, № 4. – P. 802–809. doi:10.1016/j.jtcvs.2013.06.007.
8. Milgalter, E., Laks H. Dacron mesh wrapping to support the aneurysmally dilated or friable ascending aorta / E. Milgalter, H. Laks // Ann Thorac Surg. – 1991. – Vol. 52, № 4. – P. 874–876.
9. Doylea, M. Rarefaction of the aorta under Dacron wrap: a rare complication. Interactive CardioVascular and Thoracic. Surgery. – 2014. – Vol. 19. – P. 341–343.
10. Bauer, M. Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta // Ann. Thorac. Surg. – 2003. – Vol. 75. – P. 583–584.
References
1. Reduction aortoplasty for dilatation of the ascending aorta in patients with bicuspid aortic valve / M. Bauer [et al.] // Ann. Thorac. Surg. – 2002. – Vol. 73. – P. 720–723.
2. Aortic Wrapping for a Dilated Ascending Aorta in Bicuspid Aortic Stenosis / M. S. Choi [et al.] // Circulation. – 2015. – Vol. 79. – P. 778–784.
3. ESC (2014) Guidelines on the diagnosis and treatment of aortic diseases / Europ. Heart J. – 2014. – Vol. 35. – P. 2873–2926.
4. Plonek, T. A metaanalysis and systematic review of wrapping of the ascending aorta. / T. Plonek // J. Card. Surg. – 2014. – Vol. 29, № 6. – P. 809–815. doi:10.1111/jocs.12448.
5. Short-term outcomes of aortic wrapping for mild to moderate ascending aorta dilatation in patients undergoing cardiac surgery / J. Y. Park [et al.] // Korean J. Thorac. Cardiovasc. Surg. – 2012. – Vol. 45, № 3. – P. 148–154. doi:10.5090/kjtcs.2012.45.3.148.
6. Long-term experience of girdling the ascending aorta with Dacron mesh as definitive treatment for aneurysmal dilation / O. Cohen [et al.] // Ann Thorac Surg. – 2007. – Vol. 83, № 2. – P. 780–784. doi:10.1016/j.athoracsur.2006.10.086.
7. Management of dilated ascending aorta during aortic valve replacement: valve replacement alone versus aorta wrapping versus aorta replacement / S. H. Lee [et al.] //J. Thorac. Cardiovasc. Surg. – 2013. – Vol. 146, № 4. – P. 802–809. doi:10.1016/j.jtcvs.2013.06.007.
8. Milgalter, E., Laks H. Dacron mesh wrapping to support the aneurysmally dilated or friable ascending aorta / E. Milgalter, H. Laks // Ann Thorac Surg. – 1991. – Vol. 52. № 4. – P. 874–876.
9. Doylea, M. Rarefaction of the aorta under Dacron wrap: a rare complication. Interactive CardioVascular and Thoracic. Surgery. – 2014. – Vol. 19. – P. 341–343.
10. Bauer, M. Dislocated wrap after previous reduction aortoplasty causes erosion of the ascending aorta // Ann. Thorac. Surg. – 2003. – Vol. 75. – P. 583–584.
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