BIOMATERIALS IN AORTIC ROOT SURGERY: MID-TERM OUTCOMES

Vollständiger Abstract

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Highlights For the first time, a comparative study was conducted of the medium‑term results of using aortic homografts, autografts (Ross operation), and a domestic biological conduit in the surgical treatment of aortic root pathology. It has been shown that all three biomaterials provide high survival rates, acceptable freedom from reoperations, and stable hemodynamics in the medium term. The data obtained indicate the clinical viability of the domestic biological conduit as a competitive alternative to traditional biological solutions. Background. Surgical correction of aortic root pathology remains one of the most challenging tasks in cardiac surgery. The choice of biomaterial for aortic root reconstruction may influence long-term outcomes and the frequency of reoperations. Aim. To evaluate mid-term results of surgical treatment of aortic root pathology using different biomaterials – aortic homografts, pulmonary autografts (the Ross procedure), and “Russian conduit”. Methods. A single-center retrospective comparative study was conducted including 68 patients operated on between 2015 and 2025. Patients were divided into three groups: I – aortic homografts (n = 19), II – autografts (Ross procedure, n = 24), III – “Russian conduit” (n = 25). Primary endpoints were overall survival and freedom from reoperation on the aortic root. Secondary endpoints included structural prosthesis degeneration, root dilatation, significant regurgitation, thromboembolic, and hemorrhagic complications. Statistical analysis was performed using IBM SPSS Statistics 23.0; differences were considered significant at p < 0.05. The follow-up period varied depending on the type of surgical intervention: group I – 58.2 ± 13.9 months (36–83), group II – 74.9 ± 11.3 months (40–110), group III – 62.3 ± 14.3 months (37–84). Results. The mean age of patients was 51.1 ± 14.9 years, with a male predominance in all groups (85.3%). Groups were comparable in most demographic and clinical characteristics, except for a higher incidence of connective tissue dysplasia and infective endocarditis in group I, and more frequent cardiac rhythm disorders in group III. Overall mid-term survival was 92.6%: 89.5% in group I (2 in-hospital deaths, no late deaths), 91.7% in group II (2 late deaths), and 96.0% in group III (1 late death). Reoperations were performed only in groups II (2 cases) and III (3 cases). Echocardiography showed a statistically significant increase in maximum aortic valve velocity in group I (from 118 ± 10 cm/s to 126 ± 11 cm/s, p = 0.006), while peak and mean gradients and overall hemodynamics remained stable. Changes in maximum velocity and gradients in groups II and III were not statistically significant. Mild leaflet thickening, especially in group III, did not affect valve function. Conclusions. All studied biomaterials demonstrated high stability and functional performance of the aortic valve in the mid-term. Aortic homografts, pulmonary autografts in the Ross procedure, and “Russian conduit” provide comparable survival, low risk of reoperation, and can be considered safe and effective for reconstructive aortic root surgery.