Short-term results of surgical treatment of aneurysms and dissection of the ascending aorta using the classical Bentall technique with Cabrol anastomosis and modified by N. Kouchoukos

Mironenko V.A., Rychin S.V., Garmanov S.V., Kokoev M.B., Lisina M.O., Badmaev T.V.

Objective. To evaluate and compare the immediate results of surgical treatment of aneurysms and dissection of the ascending aorta by the classic Bentall technique with anastomosis according to Cabrol and as modified by N. Kouchoukos.

Material and Methods. We analyzed 189 patients who underwent aortic valve and ascending aorta prosthesis by Bentall-de Bono technique (n = 135) and in Kouchoukos modification (n = 49). Exclusion criteria: repeated operations, one-stage interventions on the aortic arch, heart valves, coronary bypass surgery. The mean age of patients in the first group (Bentall – de Bono technique) was 46±14.5 (14L – 73g); in the second group (Kouchoukos modification) – 50.18±12.8 (23-72 years). Both groups were predominantly male, 110 (84.6%) in the first group and 40 (81.6%) in the second group. Patients with ascending aortic aneurysm, 110 (81.4%) / 41 (83.6%); acute aortic dissection, 10 (7.6%) / 5 (10.2%); and chronic aortic dissection, 15 (11.1%) / 3 (6.1%), predominated in both groups. Etiology – CHD (bicuspid aortic valve) predominated in both groups, 53 (40.45%) / 28 (57.1%); atherosclerosis, 45 (33.3%) / 11 (22.4%); connective tissue dysplasias, 34 (17.7%) / 9 (11.4%); syphilitic aortitis, 2 (1.48%)/ 1 (2%). Both groups had severe circulatory insufficiency (NYHA FC III to IV) – 109 (83.2%) / 39 (79.5%). Mean diameter of the ascending aorta was 58.6±13.2 mm / 54.4±9.84 mm. Mean EuroScore- 6.5±4.1 (0.96–23.8) / 6.14±4.01 (1.28–14.95). The groups were not statistically significantly different on these factors (p>0.05).

Results: hospital mortality was not statistically significantly different between the groups, with 4 patients (3%) in group 1, mean Euroscore among those who died was 8.2±4.14, and 1 (2.8%) in group 2. IR time was statistically significantly higher in group 1 and amounted to 188.8±44.3 /161.1±60.2 min, respectively; aortic constriction in both groups was not statistically different – 115.27±33.9 / 117.2±54.8 min. Rethoracotomy due to bleeding in the first group was performed in 5 patients (3.8%). In all cases during revision the source of bleeding was not determined. The reason for rethoracotomy in two patients in the second group was bleeding from the left coronary anastomosis area and bleeding from soft tissues. Intraoperative blood loss in group 1 was 745.8 ml, in group 2 – 822±452 ml. The average stay in ORIT was 1.6±2.48 / 1.13±2.44 days. Duration of hospitalization – 10.9±4.28/11.5±3.3 days. The groups were not statistically different according to these parameters.

Conclusions: both techniques are optimal and have comparable immediate results of surgical treatment of aneurysms and dissection of the ascending aorta.

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