Komarov Roman Nikolaevich (Doctor of Medical Sciences, Professor, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
Tkachev Maksim Igorevich (Candidate of Medical Sciences, Associate Professor, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
Isaev Ruslan Magomedovich (PhD, assistant, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
Karakotova Almira Muratbiyevna (Cardiovascular Surgeon, Postgraduate Student, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
Varlamov Georgy Arkadievich (I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
Gailaev Ilyas Danilbekovich (I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
Choibsonov Nima-Surun Tsyren-Dashievich (I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
Maisian Tigran Artemovich (I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University))
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Introduction. The evolution of reconstructive aortic root surgery has opened new horizons in the treatment of its pathology. However, in cases where preservation of the native valve is impossible, the surgeon faces the challenge of choosing an optimal conduit. The classic Bentall mechanical conduit, while remaining the "gold standard," condemns patients to lifelong anticoagulant therapy. In the search for a physiological alternative free from this limitation, two biological strategies are of particular interest: the use of a cryopreserved aortic homograft and the creation of a composite conduit bioprosthesis (the Bio-Bentall procedure). A comparative analysis of the mid-term outcomes of these procedures is a relevant clinical task, the solution of which determines the choice of surgical tactics in each specific case.
Aim. To conduct a comparative assessment of long-term clinical results and hemodynamic efficacy of the aortic homograft and the Bio-Bentall conduit in the surgical correction of aortic root pathology.
Materials and methods. A single-center retrospective cohort study analyzed data from 41 patients divided into two groups: Group 1 (n=19) – aortic homograft implantation; Group 2 (n=22) – the Bio-Bentall procedure. The mean follow-up period was 58.2 ± 13.9 months (range 36–83 months) and 51.2 ± 22.7 months, respectively (p=0.159). Primary endpoints were in-hospital mortality, cumulative survival, freedom from a combined endpoint of major adverse cardiovascular events (MACE), and reoperation rate. Secondary endpoints included intraoperative parameters and long-term hemodynamic indicators.
Results. In-hospital mortality (n=2; 10.5% vs. n=2; 9.1%; p>0.05) and cumulative freedom from MACE at 48 months (88.9 ± 7.4% vs. 86.7 ± 8.8%; p=0.864) did not differ significantly between the groups. The complication profiles had characteristic features: in the homograft group, no reoperations were required in the long-term period, although some patients showed progression of valve dysfunction. In the Bio-Bentall group, myocardial infarctions (3 cases) and bioprosthetic thrombosis (1 case) were registered. Cumulative freedom from reoperation at 48 months was 100% in Group 1 and 92.3 ± 7.4% in Group 2 (p>0.05). The use of a homograft was associated with a longer cardiopulmonary bypass time (167.1 ± 52.0 min vs. 152.9 ± 76 min; p<0.05) and aortic cross-clamp time (130.0 ± 22.6 min vs. 109.8 ± 38 min; p<0.05). A key advantage of the homograft was its hemodynamic superiority, expressed in lower transvalvular gradients (4.6 ± 1.9 mm Hg vs. 10.7 ± 1.74 mm Hg; p<0.01) and a larger effective orifice area index (1.36 ± 0.23 cm²/m² vs. 0.93 ± 0.1 cm²/m²; p<0.01) in the long-term period.
Conclusion. Aortic homografts and the Bio-Bentall conduit demonstrate comparable and satisfactory mid-term clinical efficacy. Homograft implantation is associated with superior hemodynamics and no need for lifelong anticoagulation but requires monitoring due to the risk of valve dysfunction related to graft remodeling. The Bio-Bentall procedure is a technically reproducible alternative that requires careful planning to minimize the risk of patient-prosthesis mismatch and thrombotic events.
Keywords:aortic root, aortic homograft, Bio-Bentall procedure, reconstructive aortic surgery, prosthesis hemodynamics, valve dysfunction
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Citation link:
Komarov R. N., Tkachev M. I., Isaev R. M., Karakotova A. M., Varlamov G. A., Gailaev I. D., Choibsonov N. T., Maisian T. A. COMPARATIVE ANALYSIS OF MID-TERM RESULTS OF AORTIC HOMOGRAFT IMPLANTATION AND THE BIO-BENTALL PROCEDURE: A SINGLE-CENTER EXPERIENCE // Современная наука: актуальные проблемы теории и практики. Серия: Естественные и Технические Науки. -2026. -№02/2. -С. 176-181 DOI 10.37882/2223-2966.2026.02-2.16 |
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