Search

Aim. To analyze the literature about the results of valve-sparing operations in aortic root surgery in patients with Marfan syndrome. Methods. A comprehensive search included four databases: Pubmed, Embase, Cochrane Library, and Web of Science. Articles for analysis were selected according to the methods presented in the PRISMA 2020 guidelines. Results. The final systematic review included 19 studies and 4 meta-analyses. The findings showed that 30-day and hospital mortality rates did not exceed 2.08%. The incidence of thromboembolism over a 15-year period was 4.1 ± 2.0%. The mean rate of infective endocarditis was 0.25%. Freedom from severe aortic insufficiency 8 years after surgery was 95.2 ± 3.3%. Freedom from reoperation at 8 and 10 years was 97%. Long-term mortality was ≤ 10.57%. The 5-, 10-year survival rates were 95.4 and 84.2% respectively.Conclusion. Valve-sparing operations are more beneficial than valved conduits in patients with Marfan syndrome in the short and long-term periods. Thromboembolism, endocarditis, and bleeding were significantly more common in patients with valved conduits in the long-term period. Received 7 February 2022. Revised 16 May 2022. Accepted 18 May 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: A.U. Normuradov, R.M. lsaev, M.A. Soborov, A.I. Ropova, V.D. ReiterDrafting the article: A.U. Normuradov, R.M. lsaev, A.I. Ropova, V.D. ReiterCritical revision of the article: A.U. Normuradov, R.M. lsaevFinal approval of the version to be published: R.N. Komarov, A.U. Normuradov, R.M. Isaev, M.A. Soborov, A.I. Ropova, V.D. Reiter

Over the past 30 years, minimally invasive cardiac surgery has progressed from single case reports of operations via thoracotomy and various procedures of partial sternotomy to routine use of mini-accesses as well as fully thoracoscopic and robotic techniques. It is aortic valve surgery that implemented minimally invasive technologies most widely. The objective of this systematic review is to present state-of-the-art approaches to minimally invasive aortic valve surgery including patient selection criteria as well as evolution and state-of-the-art of the main surgical approaches. The search strategy covered international databases, such as PubMed, Scopus, Embase, and Web of Science. We used following queries: ‘minimally invasive surgery of the aortic valve’, ‘alternative surgical approaches in aortic valve surgery’, ‘minimally invasive autologous pericardium neocuspidization’. Selection of patients for minimally invasive aortic interventions should consider both the anatomy of the mediastinum and the aortic root as well as cardiac and other comorbidities. Minimally invasive approaches in aortic valve surgery include thoracotomy, partial sternotomy, and endoscopic techniques. Of particular interest is minimally invasive neocuspidization with autologous pericardium. Partial sternotomies are the most routinely used approaches in aortic valve surgery. Their cumulative outcomes allow to compare their efficacy and safety with those of classic sternotomy access within large meta-analyses. Minimally invasive autopericardial neocuspidization and endoscopic interventions on the aortic valve require further surgical experience and clinical outcomes. Received 17 January 2022. Revised 6 April 2022. Accepted 8 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: R.N. Komarov, S.V. Cherniavskii, A.N. DzyundzyaDrafting the article: O.O. Ognev, M.V. LenkovetsCritical revision of the article: A.M. IsmailbaevFinal approval of the version to be published: R.N. Komarov, O.O. Ognev, A.M. Ismailbaev, S.V. Cherniavskii, A.N. Dzyundzya, M.V. Lenkovets

Background. As long as the design of leaflets is crucial for aortic valve replacement, inaccurate reconstruction can result in failure or stenosis postoperatively.Aim. To analyze average parameters of normal valve leaflets and to assess the correlation between various parameters of a normal aortic valve and personal morphometrics. Methods. The morphometrics of the aortic root were assessed on 54 specimens of the adult heart without any valvular abnormality. We measured following parameters: circumference of the ventriculo-aortic junction and the sino-tubular junction; inter-commissural distance, length of free margin, length of cusp attachment, and height for right coronary, non-coronary, and left coronary aortic leaflets. Results. Based on the average values, the left coronary leaflet is distinguished by the smallest dimensions of the length of free margin and length of cusp attachment. The height of the left coronary leaflet is maximum as compared to the right coronary and non-coronary leaflets, but these differences are minimal (up to 0.2 mm), where the left coronary leaflet is the smallest. Statistically, no significant intergroup difference was found. For all valve sizes, p > 0.05 (inter-commissural distance p = 0.083, length of free margin p = 0.331, length of cusp attachment p = 0.056, height of leaflet p = 0.518). Significant correlations were found between all aortic valve leaflet sizes and the ventriculo-aortic junction and the sino-tubular junction. A weaker correlation was found between all leaflets sizes and the body height.Conclusion. The findings can be used to optimize the leaflet reconstruction and improve the aortic valve function. Received 9 September 2020. Revised 10 September 2021. Accepted 29 June 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: R.N. Komarov, V.N. Nikolenko, S.N. OdinokovaData collection and analysis: S.N. Odinokova, V.V. Studennikova, L.O. SeverginaStatistical analysis: S.N. OdinokovaDrafting the article: S.N. Odinokova, R.Kh. BelkharoevaCritical revision of the article: R.N. Komarov, V.N. NikolenkoFinal approval of the version to be published: S.N. Odinokova, R.N. Komarov, V.N. Nikolenko, L.O. Severgina, V.V. Studennikova, R.Kh. Belkharoeva

The BioBentall procedure has many options, but the optimal approach is still not determined. Alternative options for aortic root surgery include Ross procedure and modification of the Bentall – De Bono procedure using autologous pericardium leaflets. This literature review showed topical issues of surgical technique and the results of various modifications of the BioBentall operation, as well as methods of the aortic root repair using autologous materials. The search strategy included the analysis of international (PubMed, Scopus, Embase) and Russian’s databases (Russian Science Citation Index). The BioBentall procedure demonstrates satisfactory early and long-term results comparable to both the classic Bentall – De Bono procedure and valve-sparing techniques. Composite grafts containing frameless bioprostheses seem to be more promising and durable in comparison with stent-grafts, however, given the minimal amount of publications directly comparing these techniques, further study of this hypothesis is necessary. Total xenopericardial conduits have demonstrated higher rates of degradation and are currently not recommended for use, as demonstrated in most foreign studies. Modified Ross procedure shows excellent hemodynamic outcomes in the long-term follow-up, however, the literature data regarding its applicability in a cohort of patients with proximal aortic aneurysms are limited. The combination of the Bentall – De Bono procedure and autopericardial neocuspidization seems to be a promising and cost-effective method, however, this approach requires a clinical assessment, which results have not been yet published. Received 26 February 2022. Revised 20 April 2022. Accepted 21 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: R.N. Komarov, A.M. IsmailbaevDrafting the article: A.N. Dzyundzya, A.O. Danachev, O.O. Ognev, M.V. LencovetsCritical revision of the article: S.V. CherniavskiiFinal approval of the version to be published: R.N. Komarov, A.M. Ismailbaev, S.V. Cherniavskii, A.N. Dzyundzya, A.O. Danachev, O.O. Ognev, M.V. Lencovets