No abstract

Up to 30 % of all ischemic heart disease patients present with some degree of ischemic mitral regurgitation. It is proven that any grade adversely affects long-term outcomes. Surgical revascularization and restoration of the valvular function both trigger left atrial and ventricular reverse remodeling and improve the prognosis.

PURPOSE: Pathology of the aortic root and aortic valve is subjected to adult cardiac surgery and includes Stanford A aortic dissection, annuloaortic ectasia or chronic aneurysm of the ascending aorta. In such cases, Bentall-De Bono procedure is usually preferred. Aortic valve reimplantation by using Tirone David's technique presenting with the advantages of valve-sparing surgery can be performed in selected cases. MATERIAL AND METHODS: A retrospective analysis of a three-year experience with the complex surgical treatment of diseases of the aortic valve and root was carried out. During the period from January 1, 2009 to December 31, 2012, fifty-three patients with aortic valve and aortic root pathology were treated in the Division of Cardiac Surgery, St. Marina University Hospital of Varna. Bentall procedure was carried out in 37 patients (Group B). In 19 of them (51%) emergency surgery was done for acute aortic dissection of type Stanford A. The rest 18 patients underwent elective surgery for dilated ascending aorta and aortic valve dysfunction. Aortic valve-sparing surgery by David's technique for aortic aneurysm was accomplished in 16 patients (Group D). This technique was emergently applied in one patient with aortic dissection, too. Baseline data, intraoperative details, early results and complications were compared. RESULTS: Early (30-day) mortality after Bentall-De Bono procedure was 10,5% (0% after elective surgery and 21,1% after dissection repair). All the patients survived after David's procedure that proved the significant advantages of the valve-sparing surgery. CONCLUSION: The aortic valve reimplantation provides long-term results that are comparable to those after the Bentall-De Bono procedure such as high survival rates, low incidence rate of endocarditis, and slightly higher risk of reinterventions. There is no need of lifelong anticoagulation that improves patient's quality of life.