Indications for Valve-Sparing and Reconstructive Aortic Root Surgery: A Retrospective Cohort Study

Highlights The review presents the results of valve-sparing and reconstructive aortic root surgeries. The results of the analysis of patients` data can help specialists to compare and develop novel approaches to the treatment of patients with aortic root diseases. The presented “Russian conduit” procedure developed by the authors is an option for treatment of the aortic valve and aortic root defects. Aim. To develop an optimal technique for surgical treatment of aortic root pathologies. The review presents data on modern surgical approaches in the management of the disease, including the Bentall-De Bono procedure, “classic” and “modified” David procedures, the “Russian Conduit” procedure, and the Ross procedure. Methods. The retrospective study involved 183 patients who underwent surgeries for aortic root pathologies. Patients were divided into five groups based on the surgical techniques. Clinical and laboratory data were evaluated in the mid-term postoperative period. Statistical analysis included comparative methods using various criteria and tests. Results. The David procedure was advantageous over the Bentall-De Bono procedure for patients with intact aortic valve leaflets. The “Russian conduit” procedure demonstrated safety and durability comparable to the classic David procedure, along with good hemodynamic performance. There was a higher frequency of residual aortic regurgitation following leaflet repair within the “modified” David procedure. Conclusion. The results confirm that techniques using autologous tissues, such as the “Russian conduit” and “Protected Ross” are effective and safe alternatives to traditional replacement methods. The David procedure remains preferable for patients without leaflet damage, while procedures involving complete replacement are advisable for patients with severe valve pathology.