Current anatomical ideas about the aortic root structure from surgical point of view

Комаров, Р. Н.; Katkov, A. I.; Odinokova, S. N.

doi:10.17116/kardio201912051433

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…De Bono, 1968). Однако снижение качества жизни, связанное с необходимостью приема антикоагулянтов, и ассоциированные с этим осложнения требуют продолжения поиска альтернативных методов лечения этой патологии [4][5][6]. Современной тенденцией в лечении больных кардиохирургического профиля является выполнение реконструктивных операций с целью воссоздания нативной анатомии сердечных структур.…”

Section: Abstract: Aortic Valve Morphometry Aortic Root Heart Reconstructive Surgeryunclassified

The correlations of morphometric parameters of structures of the aortic root having practical significance in the surgical correction of the aortic valve

et al. 2020

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Successful reconstruction of the aortic valve requires the preliminary creation of the anatomical design of its image, which includes a set of parameters of the valves of a particular valve. Errors in operation at the stage of design of valve components are fraught with subsequent dysfunction. In the present, the optimal sizes of the aortic root and the valves of the aortic valve were evaluated and the presence and values of correlations between them were determined. Statistically significant anatomical and functional correlations of morphometric characteristics of aortic root structures were revealed to achieve the optimal level of their correspondence in autologous grafts during surgical correction of the aortic valve. The main morphometric parameters of the aortic root were analyzed on the example of 54 samples obtained post mortem from patients whose death occurred from causes not associated with heart disease. The cases with aortic valve disease were excluded from the study. The following parameters were evaluated: circumference of the ventriculo-arterial junction; circumference of the sinuses of Valsalva; circumference of the sinutubular junction. Separately, for each of the three cusps of the native aortic valve, were evaluated: the length of the free edge of the cusp (L1); the length of the junction of the leaflet and the fibrous ring of the aortic valve (L2); leaflet height (A); intercommissural distance (IC). A search was made for the correlation between the size of the valves and the parameters of the circumference of the aortic root at the level of the ventriculo-arterial junction, of the sinuses of Valsalva and of sinutubular junction. A significant presence of a correlations was found between all parameters of the aortic valve cusps and the length of the aortic circumference at the level of the ventriculo-arterial junction, of the sinuses of Valsalva and sinutubular junction (r>0.6 for IC, L1, L2 and r>0.5 for A at p<0,01). The data obtained by correlation analysis make it possible to standardize the design of the autograft of the aortic valve, thereby ensuring the best coaptation of the valves and, as a result, the function of the aortic valve.

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Section: Abstract: Aortic Valve Morphometry Aortic Root Heart Reconstructive Surgeryunclassified

The correlations of morphometric parameters of structures of the aortic root having practical significance in the surgical correction of the aortic valve

et al. 2020

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Historical aspects of aortic valve replacement using autologous pericardium: do we know everything?

Комаров

Tkachev

Savina

et al. 2023

Kompleks. probl. serdečno-sosud. zabol.

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Highlights. The article describes the contribution of foreign and Russian surgeons to the development of aortic valve replacement using autologous tissue, and presents the evolution of the technique. The authors tried to answer the question whether the Japanese professor S. Ozaki actually developed something new or the discovery was already made 40 years ago. At the end of the article, the technique developed by a Russian cardiac surgeon is presented, casting doubt on the use of templates in this procedure.Abstract. Aortic valve replacement using autologous pericardium (neocuspidalization) is becoming an increasingly attractive option that can be applied to a wide range of aortic valve diseases. This technique avoids the need for lifelong administration of anticoagulant drugs, and provides the maximum effective orifice area, resulting in a low transvalvular gradient. The new technique, introduced by Shigeyuki Ozaki, has made the procedure more reproducible with promising medium- and longterm results. But is Ozaki the predecessor of this technique or is “all new is well forgotten old”? This review focuses on the historical aspects of the development of neocuspidalization of the aortic valve using autologous pericardium, the first interventions for valve reconstruction are mentioned, the evolution in the technique of preparation and fixation of the leaflets is reflected.

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Aortic Valve Replacement Using Autologous Pericardium Without Templates: Short and Mid-Term Outcomes

Komarov,

Tkachev,

Isaev

et al. 2023

Kompleks. probl. serdečno-sosud. zabol.

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HighlightsWe have described the outcomes of aortic valve replacement using autologous pericardium without special templates. Although S. Ozaki is considered by many to be the founder of neocuspidization technique, the methods for sizing of the neocusps were proposed long before him. The method of the Japanese professor involves using special templates. This article presents a mathematical formula to calculate neocusps` size, which significantly simplifies the procedure, and makes it possible to perform it in centers that do not possess Ozaki templates. Abstract Aim: To describe an original technique of aortic valve replacement using autologous pericardium without templates. The calculation of the neocusps` size is based on the diameter of aortic annulus, which can be estimated both intraoperatively and preoperatively, helps to reduce the duration of surgery, CPB time and myocardial ischemia, and lower the rates of late complications.Methods: The prospective study included 34 patients with aortic valve disease admitted to the Cardiac Surgical Department of the University Clinical Hospital No.1 of the First Moscow State Medical University named after I.M. Sechenov, Ministry of Health of Russia in the period from January 2020 to March 2023. The mean age of the patients was 51±17 years (from 19 to 78 years). Gender distribution in the total group was as follows: male 50% (n = 17), female 50% (n = 17). All patients underwent aortic valve replacement using autologous pericardium without templates (by calculating the neocusps` size). Isolated aortic valve replacement was performed in 17 patients (50%), ascending aorta replacement in 11 patients (32.3%), mitral valve intervention in 5 (14.7%), coronary artery bypass grafting in 3 (8.8%) cases. 11 patients (32.3%) had aortic valve stenosis, 4 patients (11.7%) had insufficiency, and 19 patients (55.8%) had both stenosis and insufficiency. Bicuspid aortic valve was detected in 18 patients (52.9%). All patients were divided into two groups: Komarov (aortic valve replacement only) and Komarov Plus (aortic valve replacement and treatment for concomitant cardiac pathology).Results: There were no cases of conversion to traditional aortic valve replacement using prosthetic valves. There were 2 cases of in-hospital mortality; according to medical records, death in both cases was due to complications provoked by double pneumonia caused by SARS-CoV-2. 1 patient required reoperation 4 months after the intervention due endocarditis caused by Streptococcus viridans. In the midterm follow-up period, hemodynamic parameters such as peak gradient, mean gradient, and peak velocity were 11.96±4.70 mm Hg, 5.88±2.07 mm Hg, 168.19±30.56 mm Hg.Conclusions: The obtained valve prosthesis is anatomically analogous to the native valve and provides reliable peak pressure reduction, no postoperative regurgitation, and increased effective orifice area. The proposed method is safe and can serve as an alternative to the Ozaki procedure, in which the neocusps are outlined using special templates.

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Current anatomical ideas about the aortic root structure from surgical point of view

Cited by 3 publications

References 34 publications

The correlations of morphometric parameters of structures of the aortic root having practical significance in the surgical correction of the aortic valve

The correlations of morphometric parameters of structures of the aortic root having practical significance in the surgical correction of the aortic valve

Historical aspects of aortic valve replacement using autologous pericardium: do we know everything?

Aortic Valve Replacement Using Autologous Pericardium Without Templates: Short and Mid-Term Outcomes

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