Calcific aortic stenosis is one of the most common valvular heart diseases, which may require surgery. Regardless of the etiology, the consequence of this disease is concentric hypertrophy of the left ventricle and progressive myocardial fibrosis, independently affecting the long-term survival of patients after aortic valve replacement. "Open" surgical or transcatheter aortic valve replacement is the only effective way to treat aortic stenosis. "Open" surgical procedure remains the "gold standard", however, transcatheter aortic valve replacement is characterized by rapid development and expansion to the population of moderate and low-risk patients. For a comparative assessment of the effectiveness and safety of transcatheter and "open" surgical procedures in patients of different risk categories, OBSERVANT, NOTION, PARTNER, случаев, с применением бесшовных протезов аортального клапана. Таким образом, вопрос об оптимальном методе коррекции тяжелого аортального стеноза у пациентов умеренного и высокого хирургического риска остается открытым. В процессе ведения подобных больных важно учитывать индивидуальные особенности пациентов и стремиться к персонализации лечения.Ключевые слова: аортальный клапан, аортальный стеноз, гипертрофия, протезирование клапана сердца, транскатетерное протезирование аортального клапана, фиброз.

Background: Ascending aortic (AA) dilatation is common in patients with bicuspid aortic valve (BAV). In BAV replacement, surgery of the AA is indicated in the case if AA diameter exceeds 45 mm. Aortic valve replacement combined with an AA intervention is associated with increased risk of complications. The feasibility of the reduction ascending aortoplasty for correction of the dilated AA remains disputable.Aim: To analyze the results of BAV surgical replacement with simultaneous surgical correction of the borderline AA dilatation (45-50 mm) by the reduction aortoplasty (RAP) or supracoronary AA replacement (SPR).Materials and methods: This single center prospective non-randomized study included 53 patients with significant BAV stenosis and AA dilatation (45-50 mm), divided into 2 groups: BAV surgical replacement combined with RAP AA replacement (group 1, 36 patients) and BAV replacement with SPR (group 2, 17 patients). There were no significant differences between the patients of the two groups in their characteristics of the underlying disease, complications and comorbidities.Results: Hospital mortality was 0%. No between-group differences in the early postoperative course were found. At later term, 44 (81.5%) patients were assessed; median (dispersion) of the follow-up was 36 (25; 50) months. Two patients from the group 2 died during the follow-up. The long-term survival was better in the group 1 (p = 0.028). No differences in the combined adverse event rate were observed between the groups (p = 0.633). The median (dispersion) of the AA absolute increment and the rate of dilatation after RAP were 1.0 (0.0; 3.0) mm and 0.24 (0.00; 0.95) mm/year, respectively. The predictor of AA increment rate ≥ 2 mm/year was the baseline blood pressure level (odds ratio 1.321, 95% confidence interval 1.050-1.662; p=0.017). The threshold preoperative blood pressure value for the increased risk of the long-term AA expansion rate was 138 mmHg.Conclusion: The efficacy and safety of RAP and SRP combined with BAV replacement in AA borderline dilatation are similar. Combined BAV surgery and RAP is effective and safe in patients with systolic blood pressure level ≤ 135 mmHg. Combined BAV replacement with SRP seems reasonable in patients with arterial hypertension.