Russian conduit: a new approach in aortic root and ascending aortic surgery. Immediate and mid-term results in a single center

Background. There was a trend towards valve-sparing techniques in aortic root surgery in recent decades. This approach can significantly improve the quality of life and do not require anticoagulation. There is a question on surgical strategy for patients with native aortic leaflets not suitable for reconstruction. We describe an alternative technique of aortic root replacement with certain advantages in mid-term period compared to standard Bio Bentall procedure. Material and methods. The study included 50 patients who underwent surgery for aortic root and ascending aorta lesions between 2014 and 2022. Mean follow-up was 31.0±17.9 months in the group «Russian conduit» and 39.2±22.7 months in the group 2 «BioBentall» (p=0.159). In the 1st group, patients (n=28) underwent a combined Bentall-De Bono procedure and aortic valve neocuspidization with autologous pericardium. In the 2nd group (n=22), surgery was performed using synthetic composite conduit containing biological aortic root stented prosthesis. Results. In the 1st group, there were no conversions to standard Bentall or BioBentall procedure. Cumulative freedom from MACE (delayed all-cause mortality, acute myocardial infarction, stroke, infective endocarditis) after 12, 24, and 48 months was similar (92.59±5.04% versus 100% (p=0.367), 88.7±6.1% versus 93.3±6.4% (p=0.534) and 88.7±6.1% versus 86.7±8.8% (p=0.864)). Freedom from redo surgeries throughout 48 months was 92.59±5.04% and 92.3±7.4%, respectively (p=0.734). Indexed effective orifice area in mid-term period was significantly larger in the 1st group (1.36±0.23 versus 0.93±0.1 cm2, p<0.01). Conclusion. Aortic root and ascending aortic replacement using Russian conduit technique demonstrates comparable results regarding freedom from redo surgeries compared to standard BioBentall technique and better hemodynamic parameters (mean pressure gradient and effective orifice area) in mid-term period. This approach may be successfully used for aortic root disease if reconstruction of native cusps is not possible.