kurskvestЧеловек и его здоровьеHumans and their health1998-57461998-5754Kursk State Medical University10.21626/vestnik/2023-4/03TZKHTXkurskvest-1233Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEХирургическое лечение клапанного аортального стеноза в сочетании с узким корнем аорты. Место задней аортопластики у взрослых. Обзор потребности в этой операции, техник ее выполнения и нашего опытаSurgical treatment of valvular aortic stenosis in combination with a narrow aortic root. The site of posterior aortoplasty in adults. An overview of the need for this operation, its execution techniques and our experience. Literature reviewhttps://orcid.org/0000-0003-1989-7842СазоненковМаксим АлександровичSazonenkovMaxim A.

д-р мед. наук, профессор, сердечно-сосудистый хирург, БОКБ, г. Белгород

Dr. Sci. (Med.), Professor, Cardio-thoracic surgeon, BRCH, Belgorod, Russian Federation

sazonenkov@mail.ruhttps://orcid.org/0000-0002-5396-5784ТатаринцевАндрей МихайловичTatarintsevAndrey M.

аспирант, хирург, БОКБ, г. Белгород

tatam-72@mail.ruhttps://orcid.org/0000-0003-4335-5365ИсматовХушбахтджон ХасановичIsmatovKhushbakhtdzon Kh.

аспирант кафедры госпитальной хирургии, НИУ БелГУ, г. Белгород

Post-graduate student of the Department of Hospital Surgery, NRU "BelSU", Belgorod, Russian Federation

khushbakht2018@mail.ruhttps://orcid.org/0000-0002-0348-1503МоскалевАндрей СергеевичMoskalevAndrey S.

Student, NRU "BelSU", Belgorod, Russian Federation

Student, NRU "BelSU", Belgorod, Russian Federation

andmos31@yandex.ruБелгородская областная клиническая больница Святителя Иоасафа (БОКБ); Белгородский государственный национальный исследовательский университет (НИУ БелГУ)РоссияBelgorod Regional Clinical Hospital (BRCH); Belgorod State National Research University (NRU "BelSU")Russian FederationБелгородский государственный национальный исследовательский университет (НИУ БелГУ)РоссияBelgorod State National Research University (NRU "BelSU")Russian Federation2023291220232642841Copyright © Сазоненков М.А., Татаринцев А.М., Исматов Х.Х., Москалев А.С., 20242024Сазоненков М.А., Татаринцев А.М., Исматов Х.Х., Москалев А.С.Sazonenkov M.A., Tatarintsev A.M., Ismatov K.K., Moskalev A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.kursk-vestnik.ru/jour/article/view/1233

Цель - описать современное состояние проблемы хирургического расширения корня аорты при протезировании аортального клапана. Замена аортального клапана - радикальная операция, направленная на уменьшение клиники хронической сердечной недостаточности, снижение перегрузки левого желудочка, регресс его гипертрофии. Материалы и методы. Изучены последние данные литературы о месте хирургического расширения корня аорты в проблеме лечения аортального стеноза. Приведен собственный опыт данных операций при имплантации механических и биологических протезов в аортальную позицию в практике кардиохирургического отделения Белгородской областной клинической больницы. Результаты. Мы провели обзор литературы и наш опыт хирургического ведения ситуаций узкого корня аорты для выявления частоты протез-пациент несоответствия (ППН) и необходимости дополнительной хирургической процедуры задней аортопластики для вмещения соответствующего размера протеза. Приведен опыт кардиохирургического отделения БОКБ за период 01.01.2015-30.04.2023 гг. по протезированию аортального клапана при малом размере аортального кольца (17-20 мм). Материал исследования составили 303 пациента. Как протез-пациент несоответствие мы определили все случаи выполнения задней аортопластики с имплантацией должного размера аортального протеза. По данным современных исследований частота протез-пациент несоответствия при протезировании аортального клапана без пластики корня аорты составляет 11-33%. Частота выполнения операции задней аортопластики у взрослых составляет по данным разных авторов 5-40%. Наш опыт показал, что ситуация ППН, потребовавшая пластики аорты, встретилась в 14,8% случаев имплантации каркасных биологических протезов, в 17,3% случаев имплантации механических двухстворчатых протезов. В целом в среднем пластика аорты была выполнена в 15,8% случаев. Протез-пациент несоответствие при протезировании аортального клапана встречается с относительно постоянной частотой. Задняя аортопластика позволяет имплантировать расчетный размер протеза и избежать этой проблемы. Заключение. Операция расширения заплатой корня аорты для вмещения должного размера протеза в аортальную позицию требуется в 15-30% случаев пациентов с узким аортальным кольцом.

Aim: to describe the current state of the problem of surgical expansion of the aortic root during aortic valve replacement. Aortic valve replacement is a radical operation aimed at reducing the symptoms of chronic heart failure, reducing left ventricular overload, regressing its hypertrophy, and thereby increasing the quality and life expectancy of the patient. For the greatest success of the operation, the replacement should be made with the appropriate valve size suitable for the particular patient. Materials and methods. The latest literature data on the place of surgical expansion of the aortic root in the problem of treating aortic stenosis were studied. The own experience of these operations during the implantation of mechanical and biological prostheses in the aortic position in the practice of the cardiosurgical department of the Belgorod Regional Clinical Hospital is presented. Results. The study is devoted to the actual problem of choosing the right size of the prosthesis, the frequency of additional surgical procedures for its placement. Many studies have established an association between prosthesis-patient mismatch (PPM) and surgical outcome. The association of prosthesis-patient mismatch with long-term survival is inverse, although sometimes reported as ambiguous. We reviewed the literature and our experience with the surgical management of narrow aortic root situations to determine the incidence of PPM and the need for an additional surgical procedure of posterior aortoplasty to accommodate the appropriate size of the prosthesis. The results of modern meta-analyses, multicenter studies and limited series of operations presented in the literature are reviewed. The experience of the cardiosurgical department of the Belgorod Regional Clinical Hospital for the period 01.01.2015-30.04.2023 in aortic valve replacement with a small size of the aortic ring (17-20 mm) is presented. The study material consisted of 303 patients. As prosthesis-patient mismatch, we defined all cases of posterior aortoplasty with implantation of an appropriately sized aortic prosthesis. According to modern studies, the incidence of prosthesis-patient mismatch in aortic valve replacement without aortic root plasty is 11-33%. The frequency of posterior aortoplasty in adults is, according to different authors, 5-40%. Our experience has shown that the situation of PPM, which required aortic plasty, occurred in 14.8% of cases of implantation of stented biological prostheses, in 17.3% of cases of implantation of mechanical bicuspid prostheses. In general, on average, aortic plasty was performed in 15.8% of cases. Prosthetic-patient mismatch in aortic valve replacement occurs at a relatively constant rate. Posterior aortoplasty allows implanting the calculated size of the prosthesis and avoiding this problem. Conclusion. Surgery to patch the aortic root to accommodate an adequately sized prosthesis in the aortic position is required in 15-30% of patients with narrow aortic annulus. It allows you to get good hemodynamic results. The surgical risk of the operation is low.

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