Short-term results of thoracic aorta aneurysm repair and aortic valve reimplantation

Aim: The study was designed to summarize short-term results of aortic valve reimplantation (David procedure) in patients suffering from thoracic aorta aneurysm and aortic valve insufficiency. Methods: 132 patients were operated for various types of aorta pathology and aortic valve insufficiency, including 56 patients with acute and subacute aortic dissection and 76 patients with chronic aortic aneurysm with or without dissection. Different types of surgical interventions were offered to patients: ascending aorta replacement with aortic valve reimplantation (88 cases), hemiarch replacement (11 cases), Borst procedure (17 cases), stent-graft implantation (16 cases) and other concomitant interventions including CABG, valve repair or replacement. The efficacy of aortic valve functioning was evaluated by using intraoperative transoesophageal ultrasound imaging in 129 cases and transthoracic ultrasound imaging in immediate postoperative period in 119 cases. Results: Satisfactory hemodynamic parameters of aortic valve functioning were recorded in the majority of patients: Grade 0 aortic insufficiency - 10 patients, Grade 1-1+ - 100 patients and Grade 2-2+ was registered in 10 patients. Despite the fact that functional parameters of the aortic valve following the David procedure were positive in most patients, overall hospital mortality ran to 12.1% (16 patients). Hospital mortality depended on the nature of intervention (emergency or elective surgery), as well as on the general complexity related with the extent of the intervention. In the group of patients who underwent emergency and elective interventions, hospital mortality accounted for 19.6% (11 patients) and 6.5% (5 patients) respectively. Conclusion: David procedure in patients suffering from ascending aorta aneurysm is an effective treatment option in terms of aortic valve functional recovery in cases of acute or chronic aortic valve insufficiency.