SURGICAL MANAGEMENT OF PATIENTS WITH ASCENDING AORTIC ANEURYSMS

B.A. Konstantinov, Yu.V. Belov, A.B. Stepanenko, A.P. Gens, E.R. Charchyan
Department of Surgery of Aorta and Its Branches, Russian Scientific Center of Surgery, Russian Academy of Medical Sciences,
Moscow, Russia

Between 1988 and 2002, 104 patients with ascending aortic aneurysms were operated on. The patients were distributed into 2 groups: the first group presented with aortic incompetence (n=66) and the second one had no aortic incompetence (n=38). In the first group, 8 patients received valve sparing operations, 58 (88%) patients underwent replacement of the aortic valve and ascending aortic segment according to different techniques. In the second group, 20 (53%) patients underwent graded aneurysmal resection and intima sparing exoreplacement by synthetic grafts and 18 (47%) were provided supravalvular replacement of the ascending aorta. In the short term postoperative period, the lethality in the first group accounted for 3% (6 patients), in the second group, it was equal to 2.6% (1 patient): of note, in the group provided aortoplasty, the lethality was 0%. In ascending aortic aneurysm associated with aortic incompetence, the Bentall DeBono operation is the method of choice of surgical treatment. Valve sparing operations are to be performed according to strict indications (in the absence of anuloaortic ectasia and microscopic lesions of aortic valve cusps). The graded resection of aneurysm with intima sparing exoreplacement may be an alternative to linear replacement of the ascending aorta in ascending aortic aneurysm without aortic incompetence and in the absence of aortic wall dissection.

KEY WORDS: ascending aortic aneurysm, surgical management.

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