kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2022-11-4S-182-193kpccz-1283Research ArticleОНЛАЙН. АНАЛИТИЧЕСКИЙ ОБЗОР. Сердечно-сосудистая хирургияONLINE. REVIEW. Cardiovascular surgeryРемоделирование против реимплантации в хирургии корня аорты: сравнительные результаты и факторы риска аортальной недостаточностиRemodeling versus reimplantation in aortic root surgery – comparative results and risk factors for aortic insufficiencyhttps://orcid.org/0000-0002-3904-6415КомаровР. Н.KomarovR. N.

Комаров Роман Николаевич - доктор медицинских наук, заведующий кафедрой факультетской хирургии № 1.

ул. Трубецкая, 8, стр. 2, Москва, 119991

Roman N. Komarov - PhD, Head of the Faculty Surgery Department No. 1, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

8-2 Trubetskaya St., Moscow, 119991

https://orcid.org/0000-0001-8545-3276ИсмаилбаевА. М.IsmailbaevA. M.

Исмаилбаев Алишер Маккамджанович - кандидат медицинских наук, доцент кафедры факультетской хирургии № 1.

ул. Трубецкая, 8, стр. 2, Москва, 119991

Alisher M. Ismailbaev - PhD, Associate Professor at the Faculty Surgery Department No. 1, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

8-2 Trubetskaya St., Moscow, 119991

alisher77786@bk.ruhttps://orcid.org/0000-0003-1133-8106ДзюндзяА. Н.DzyundzyaA. N.

Дзюндзя Андрей Николаевич - врач – сердечно-сосудистый хирург.

ул. Трубецкая, 8, стр. 2, Москва, 119991

Andrey N. Dzyundzya - Cardiovascular Surgeon at the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

8-2 Trubetskaya St., Moscow, 119991

https://orcid.org/0000-0001-7381-7925ЧернявскийС. В.ChernyavskiiS. V.

Чернявский Станислав Вячеславович - кандидат медицинских наук, заведующий кардиохирургическим отделением.

ул. Трубецкая, 8, стр. 2, Москва, 119991

Stanislav V. Chernyavskiy - PhD, Head of the Cardiac Surgery Department, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

8-2 Trubetskaya St., Moscow, 119991

https://orcid.org/0000-0002-8246-3708БадалянС. С.BadalyanS. S.

Бадалян Самсон Сергеевич – аспирант.

ул. Трубецкая, 8, стр. 2, Москва, 119991

Samson S. Badalyan - Postgraduate student, I.M. Sechenov First Moscow State  Medical  University  of the Ministry of Health of the Russian Federation (Sechenov University).

8-2 Trubetskaya St., Moscow, 119991

https://orcid.org/0000-0001-9296-3119ДаначевА. О.DanachevA. O.

Даначев Александр Одиссеевич - кандидат медицинских наук, врач – сердечно-сосудистый хирург.

ул. Трубецкая, 8, стр. 2, Москва, 119991

Aleksandr O. Danachev - PhD, Cardiovascular Surgeon, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).

8-2 Trubetskaya St., Moscow, 119991

https://orcid.org/0000-0002-9305-2250ОгневО. О.OgnevO. O.

Огнев Олег Олегович – аспирант.

ул. Трубецкая, 8, стр. 2, Москва, 119991

Oleg O. Ognev - Postgraduate student, I.M. Sechenov First Moscow State Medical  University  of the Ministry of Health of the Russian Federation (Sechenov University).

8-2 Trubetskaya St., Moscow, 119991

Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian Federation202204022023114Sприложение182193Copyright © Комаров Р.Н., Исмаилбаев А.М., Дзюндзя А.Н., Чернявский С.В., Бадалян С.С., Даначев А.О., Огнев О.О., 20232023Комаров Р.Н., Исмаилбаев А.М., Дзюндзя А.Н., Чернявский С.В., Бадалян С.С., Даначев А.О., Огнев О.О.Komarov R.N., Ismailbaev A.M., Dzyundzya A.N., Chernyavskii S.V., Badalyan S.S., Danachev A.O., Ognev O.O.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/1283Основные положения

Основные положения. Основными методами клапаносохраняющей хирургии корня аорты являются реимплантация и ремоделирование.

Анализ литературы демонстрирует либо относительную идентичность клинических исходов реимплантации и ремоделирования, либо преимущество реимплантации в отношении отдаленных результатов.

Резюме

Резюме. В последние десятилетия разработаны и внедрены в широкую практику клапаносохраняющие методики протезирования корня аорты, включая реимплантацию и ремоделирование, а также их модификации. Эффективность   и долговечность этих двух подходов служит предметом бурных обсуждений в современном кардиохирургическом сообществе. Накопленный за три десятилетия глобальный опыт выполнения процедур ремоделирования и реимплантации позволяет провести всесторонний обзор результатов этих подходов. Представленный обзор литературы посвящен сравнению хирургических аспектов и клинических исходов методик реимплантации и ремоделирования, анализу целесообразности восстановления физиологической архитектоники корня аорты при клапаносберегающих операциях с использованием Вальсальва-графтов, а также оценке факторов риска резидуальной аортальной недостаточности после таких вмешательств. Стратегия поиска включила анализ международных баз данных (PubMed, Scopus, Embase) по следующим ключевым словам: reimplantation versus remodeling for aortic root valve-sparring procedures, David procedure versus Yacoub procedure, Valsalva graft for aortic root valve-sparring procedures, Valve-sparing aortic root repair with an anatomically shaped sinus prosthesis. Анализ литературы демонстрирует либо относительную идентичность ранних и отдаленных результатов реимплантации и ремоделирования, либо преимущество реимплантации в отношении свободы от поздней летальности и резидуальной аортальной недостаточности. Сохранение физиологичности корня аорты путем имплантации Вальсальва-графтов или ремоделирования обеспечивает лучшую гемодинамику и снижает напряжение на створки, однако эти постулаты идут вразрез с данными клинических исследований, посвященных анализу послеоперационных исходов и демонстрирующих отсутствие преимущества Вальсальва-графтов над линейными протезами в отношении свободы от реопераций на аортальном клапане. Остаточная послеоперационная регургитация легкой степени, эффективная высота ниже 9 мм и дополнительные вмешательства на створках являются достоверными факторами значимой аортальной недостаточности в отдаленном периоде после клапаносохраняющих операций на корне аорты.

Highlights

Highlights. The main approaches to the aortic root valve-sparing surgery of are reimplantation and remodeling;

The literature review demonstrates either the relative identity of the reimplantation and remodeling clinical outcomes, or the advantage of reimplantation in relation to long-term results.

Abstract

Abstract. In recent decades, valve-sparring methods of aortic root replacement, including reimplantation and remodeling, as well as their modifications, have been developed and put into widespread practice. The effectiveness and durability of these two approaches is the subject of discussions in the modern cardiac surgery community. The global experience in performing remodeling and reimplantation procedures allows  for a comprehensive literature review to compare the results of these approaches.  The presented review is devoted to the comparison of surgical aspects and clinical outcomes of reimplantation and remodeling techniques, the analysis of the feasibility of restoring the physiological architectonics of the aortic root in valve-sparring operations using Valsalva grafts, as well as the assessment of risk factors for residual aortic insufficiency after such interventions. The search strategy included the analysis of international (PubMed, Scopus, Embase) databases for the following keywords: “reimplantation versus remodeling for aortic root valve-sparring procedures”, “David procedure versus Yacoub procedure”, “Valsalva graft for aortic root valve-sparring procedures”, “Valve-sparing aortic root repair with an anatomically shaped sinus prosthesis”. Literature analysis demonstrates either the relative identity of early and long-term results of reimplantation and remodeling procedures, or the advantage of reimplantation in terms of freedom from late mortality and residual aortic insufficiency. Preservation of the physiology of the aortic root by implantation of Valsalva grafts or remodeling provides better hemodynamics and reduces stress on the leaflets, however, these postulates run counter to the data of clinical studies analyzing postoperative outcomes and demonstrating the lack of advantages of Valsalva grafts over linear prostheses in terms of freedom from aortic valve surgery. Residual postoperative regurgitation of a mild degree, a decrease in the effective height below 9 mm and additional interventions on the leaflets are reliable factors of significant aortic insufficiency in the long-term period after valve-sparring operations on the aortic root.

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The authors declare that there are no conflicts of interest present.