Composite grafts replacement of the aortic roots

[Intraoperative formation of the valved conduit in aortic root surgery]

AIM

To present an experience of intraoperative manufacture of the valved conduit in aortic root surgery in the Department of Cardiac Surgery of Sechenov First Moscow State Medical University.

MATERIAL AND METHODS

In our department aortic valve and ascending aortic replacement using intraoperatively manufactured valved conduit was performed in 11 patients for the period 2012-2016. Technical aspects, choice of vascular prosthesis size and type of fixation to achieve optimal hemodynamics and adequate impermeability of stitches are described.

RESULTS

Intraoperative manufacture of the valved conduit is successfully reproducible technique with good early and remote results.

CONCLUSION

Described surgical method is not accompanied by increased postoperative blood loss, CPB and aortic cross-clamping time.

Aortic root and proximal aortic arch replacement (performed by a left-handed surgeon)

We present our standard technique of composite graft replacement performed by a left-handed surgeon. This procedure is performed with a 30-day mortality comparable to that of elective isolated aortic valve replacement.

Modified Bentall procedure - 'a collar technique' to control bleeding from coronary ostia anastomoses

Composite conduit aortic root replacement has become widely accepted as the preferred treatment for ascending aorta aneurysm and dissection. We present a patient in whom creation of 'buttons' was impossible due to fragility of the ascending aorta wall. The distal anastomosis was made to the transected aorta. The remnant of the proximal ascending aortic wall was fully transected 8-9 mm above the upper edge of coronary ostia anastomoses (incorporated into conduit using inclusion technique), thus forming a 'collar' around the proximal part of the conduit. At the end of the procedure the 'collar' was anchored to the conduit to control persistent bleeding from coronary ostia anastomoses.