Альманах клинической медицины. 2019; 47: 299-309
Хирургическая коррекция погранично расширенной восходящей аорты при протезировании двустворчатого аортального клапана
https://doi.org/10.18786/2072-0505-2019-47-041Аннотация
Актуальность. Расширение восходящей аорты (ВА) часто сопутствует двустворчатому аортальному клапану (ДАК). При протезировании ДАК вмешательство на ВА рекомендуется при ее расширении > 45 мм. Усложнение протезирования аортального клапана вмешательством на ВА сопряжено с ростом риска осложнений. Дискутабельной остается применимость редукционной пластики ВА для коррекции ее расширения.
Цель - анализ результатов протезирования ДАК с одномоментной коррекцией пограничного (45-50 мм) расширения ВА методом редукционной пластики или надкоронар-ного протезирования.
Материал и методы. В одноцентровое проспективное нерандомизированное продольное исследование включены 53 пациента со значимым стенозом ДАК и расширением ВА (45-50 мм), разделенные на 2 параллельные группы: протезирование ДАК в сочетании с редукционной пластикой ВА (группа 1, n = 36) и протезирование ДАК с надкоронарным протезированием ВА (группа 2, n = 17). Пациенты в группах значимо не различались по особенностям основного заболевания, осложнениям и сопутствующей патологии.
Результаты. Госпитальная летальность - 0%. Значимых различий по особенностям госпитального периода между группами не отмечено. В отдаленные сроки обследовано 44 (81,5%) больных; медиана (границы размаха) продолжительности наблюдения составила 36 (25; 50) месяцев. Отдаленная летальность имелась в группе 2 (2 пациента). Отдаленная выживаемость была лучше в группе 1 (р = 0,028). Различий по встречаемости комплексного неблагоприятного события между группами не наблюдалось (р = 0,633). Медианы (границы размаха) абсолютного прироста и скорости расширения ВА после редукционной пластики составили 1,0 (0,0; 3,0) мм и 0,24 (0,00; 0,95) мм/год соответственно. Предиктором прироста диаметра ВА ≥ 2 мм/год был исходный уровень артериального давления (отношение шансов 1,321, 95% доверительный интервал 1,050-1,662; р = 0,017). Пороговым значением артериального давления до операции, по достижении которого возрастает риск отдаленной прогрессии расширения ВА, оказался параметр 138 мм рт. ст.
Заключение. Эффективность и безопасность редукционной пластики ВА и надкоронарного протезирования ВА при протезировании ДАК в условиях пограничного расширения ВА сходны. При уровне систолического артериального давления ≤ 135 мм рт. ст. одномоментная редукционная пластика ВА эффективна и безопасна. При наличии артериальной гипертензии целесообразным представляется надко-ронарное протезирование ВА одномоментно с протезированием ДАК.
Список литературы
1. Nkomo VT, Enriquez-Sarano M, Ammash NM, Melton LJ 3rd, Bailey KR, Desjardins V, Horn RA, Tajik AJ. Bicuspid aortic valve associated with aortic dilatation: a community-based study. Arterioscler Thromb Vasc Biol. 2003;23(2):351-6. doi: 10.1161/01.ATV.0000055441.28842.0A.
2. Ando M, Okita Y, Morota T, Takamoto S. Thoracic aortic aneurysm associated with congenital bicuspid aortic valve. Cardiovasc Surg. 1998;6(6):629-34. doi: 10.1016/S0967-2109(98)00094-5.
3. Viscardi F, Vergara C, Antiga L, Merelli S, Ven-eziani A, Puppini G, Faggian G, Mazzucco A, Luciani GB. Comparative finite element model analysis of ascending aortic flow in bicuspid and tricuspid aortic valve. Artif Organs. 2010;34( 12): 1114-20. doi: 10.1111/j.1525-1594.2009.00989.x.
4. Girdauskas E, Borger MA, Secknus MA, Gir-dauskas G, Kuntze T. Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argument. Eur J Cardiothorac Surg. 2011;39(6):809-14. doi: 10.1016/j.ejcts.2011.01.001.
5. Newby AC. Dual role of matrix metallopro-teinases (matrixins) in intimal thickening and atherosclerotic plaque rupture. Physiol Rev. 2005;85( 1 ):1 -31. doi: 10.1152/phys-rev.00048.2003.
6. Visse R, Nagase H. Matrix metalloproteinas-es and tissue inhibitors of metalloprotein-ases: structure, function, and biochemistry. Circ Res. 2003;92(8):827-39. doi: 10.1161/01.RES.0000070112.80711.3D.
7. Иртюга ОБ, Гаврилюк НД, Воронкина ИВ, Успенский ВЕ, Малашичева АБ, Моисеева ОМ. Механизмы формирования аневризмы восходящего отдела аорты различной этиологии. Российский кардиологический журнал. 2013;(1 ):14-8. doi: 10.15829/15604071-2013-1-17-19.
8. Sa MP. The aorta, the elastic tissue and cystic medial necrosis. Rev Bras Cir Cardio-vasc. 2011 ;26(1 ):III-V. doi: 10.1590/s0102-76382011000100002.
9. McKellar SH, Tester DJ, Yagubyan M, Majum-dar R, Ackerman MJ, Sundt TM 3rd. Novel NOTCH1 mutations in patients with bicuspid aortic valve disease and thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 2007;134(2): 290-6. doi: 10.1016/j.jtcvs.2007.02.041.
10. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwoger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873-926. doi: 10.1093/eurheartj/ehu281.
11. Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, Khoynezhad A, Siu SC, Verma S, Hope MD, Cameron DE, Hammer DF, Coselli JS, Moon MR, Sundt TM, Barker AJ, Markl M, Della Corte A, Michelena HI, Elefteriades JA. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg. 2018;156(2):e41-74. doi: 10.1016/j.jtcvs.2018.02.115.
12. Svensson LG, Adams DH, Bonow RO, Kou-choukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria JE, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reardon M, Reece TB, Reiss GR, Roselli EE, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic valve and ascending aorta guidelines for management and quality measures. Ann Thorac Surg. 2013;95(6 Suppl):S1-66. doi: 10.1016/j.athoracsur.2013.01.083.
13. Barili F, Pacini D, Capo A, Rasovic O, Grossi C, Alamanni F, Di Bartolomeo R, Parolari A. Does EuroSCORE II perform better than its original versions? A multicentre validation study. Eur Heart J. 2013;34(1):22-9. doi: 10.1093/eu-rheartj/ehs342.
14. Шнейдер ЮА, Кузнецов КВ, Ужахов ИР, Алешкин НГ. Метод пластики и бандажирования в лечении аневризм восходящей аорты. Вестник Санкт-Петербургской Академии последипломного образования. 2009;(2):29-32.
15. Белов ЮВ, Степаненко АБ, Генс АП, Мкртчян АН, Савичев ДД. Дозированная резекция с интимсохраняющим экзопротезированием в хирургическом лечении аневризм восходящей аорты. Кардиология и сердечно-сосудистая хирургия. 2010;(5):53-7.
16. Walker T, Bail DH, Gruler M, Vonthein R, Ste-ger V, Ziemer G. Unsupported reduction ascending aortoplasty: fate of diameter and of Windkessel function. Ann Thorac Surg. 2007;83(3):1047-53. doi: 10.1016/j.athoracsur.2006.10.022.
17. Cotrufo M, Della Corte A, De Santo LS, De Feo M, Covino FE, Dialetto G. Asymmetric medial degeneration of the ascending aorta in aortic valve disease: a pilot study of surgical management. J Heart Valve Dis. 2003;12(2): 127-33.
18. Feindt P, Litmathe J, Borgens A, Boeken U, Kurt M, Gams E. Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery? Eur J Cardi-othorac Surg. 2007;31(4):614-7. doi: 10.1016/j.ejcts.2007.01.028.
19. Скопин ИИ, Фарулова ИЮ, Цискаридзе ИМ, Акимов ИВ, Асатрян ТВ, Нерсесян ИЛ, Му-рысова ДВ, Дмитриева ЮС, Тосунян АГ. Реконструкция двустворчатого аортального клапана и редуцирующая восходящая аортопластика с наружным укреплением стенки восходящего отдела аорты. Грудная и сердечно-сосудистая хирургия. 2010;3:63-7.
20. Yalcin M, Tayfur KD, Urkmez M. Should patients undergo ascending aortic replacement with concomitant cardiac surgery? Cardiovasc J Afr. 2016;27(6):338-44. doi: 10.5830/CVJA-2016-026.
21. Lim JY, Jung SH, Kim JB, Kim DK, Chung CH, Song H, Lee JW, Choo SJ. Concomitant replacement of the dilated ascending aorta during aortic valve replacement; does it increase the perioperative morbidity and mortality risks? J Card Surg. 2013;28(3):285-90. doi: 10.1111/jocs.12111.
22. Johnston LE, Downs EA, Hawkins RB, Quad-er MA, Speir AM, Rich JB, Ghanta RK, Yar-boro LT, Ailawadi G. Outcomes for low-risk surgical aortic valve replacement: A benchmark for aortic valve technology. Ann Thorac Surg. 2017;104(4):1282-8. doi: 10.1016/j.athoracsur.2017.03.053.
23. Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Am Soc Nephrol. 2010;5(6):1003-9. doi: 10.2215/CJN.06870909.
24. Бокерия ЛА, Малашенков АИ, Скопин ИИ, Какулия ПВ, Мироненко ВА, Макушин АА. Хирургическое лечение дилатированной восходящей аорты при двухстворчатом аортальном клапане. Анналы хирургии. 2005;(4):8-13.
25. Robicsek F, Cook JW, Reames MK Sr, Skipper ER. Size reduction ascending aortoplasty: is it dead or alive? J Thorac Cardiovasc Surg. 2004;128(4): 562-70. doi: 10.1016/j.jtcvs.2004.04.032.
26. Goksuluk D, Korkmaz S, Zararsiz G, Karaagao-glu E. easyROC: An interactive web-tool for ROC curve analysis using R language environment. The R Journal. 2016;8(2):213-26.
27. Тишков АВ, Хромов-Борисов НН, Комашня АВ, Марченкова ФЮ, Семенова ЕМ, Эюбова НИ, Делакова ЕА, Быхова АВ. Статистический анализ таблиц 2 х 2 в диагностических исследованиях. СПб.: Издательство СПбГМУ; 2013. 20 с.
28. Bauer M, Meyer R, Bauer U, Goetze N, Lange PE, Hetzer R. Relation of aortic wall alterations and ascending aorta diameter in patients with bicuspid aortic valve. Z Kardiol. 2002;91(10): 818-24. doi: 10.1007/s00392-002-0847-6.
29. Robicsek F. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: an alternative to radical resection. Ann Thorac Surg. 1982;34(1): 92-4. doi: 10.1016/s0003-4975(10)60860-0.
30. Gill M, Dunning J. Is reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta? Interact Cardiovasc Thorac Surg. 2009;9(4):693-7. doi: 10.1510/icvts.2009.213405.
31. Kiessling AH, Odwody E, Miskovic A, Stock UA, Zierer A, Moritz A. Midterm follow up in patients with reduction ascending aorto-plasty. J Cardiothorac Surg. 2014;9:120. doi: 10.1186/1749-8090-9-120.
32. Tappainer E, Fiorani V, Nocchi A, Likaj E, Mem-ishaj S, Zogno M. Safe wrapping of the borderline dilated ascending aorta during aortic valve replacement. J Cardiothorac Surg. 2007;2:15. doi: 10.1186/1749-8090-2-15.
33. Lima B, Williams JB, Bhattacharya SD, Shah AA, Andersen N, Wang A, Harrison JK, Hughes GC. Individualized thoracic aortic replacement for the aortopathy of biscuspid aortic valve disease. J Heart Valve Dis. 2011;20(4):387-95.
34. Plonek T. A meta analysis and systematic review of wrapping of the ascending aorta. J Card Surg. 2014;29(6):809-15. doi: 10.1111/jocs.12448.
35. Peterss S, Bhandari R, Rizzo JA, Fang H, Kuz-mik GA, Ziganshin BA, Elefteriades JA. The aortic root: natural history after root-sparing ascending replacement in nonsyndromic aneurysmal patients. Ann Thorac Surg. 2017;103(3):828-33. doi: 10.1016/j.athoracsur.2016.06.081.
Almanac of Clinical Medicine. 2019; 47: 299-309
Surgical repair of the moderately dilated ascending aorta combined with bicuspid aortic valve replacement
https://doi.org/10.18786/2072-0505-2019-47-041Abstract
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.
References
1. Nkomo VT, Enriquez-Sarano M, Ammash NM, Melton LJ 3rd, Bailey KR, Desjardins V, Horn RA, Tajik AJ. Bicuspid aortic valve associated with aortic dilatation: a community-based study. Arterioscler Thromb Vasc Biol. 2003;23(2):351-6. doi: 10.1161/01.ATV.0000055441.28842.0A.
2. Ando M, Okita Y, Morota T, Takamoto S. Thoracic aortic aneurysm associated with congenital bicuspid aortic valve. Cardiovasc Surg. 1998;6(6):629-34. doi: 10.1016/S0967-2109(98)00094-5.
3. Viscardi F, Vergara C, Antiga L, Merelli S, Ven-eziani A, Puppini G, Faggian G, Mazzucco A, Luciani GB. Comparative finite element model analysis of ascending aortic flow in bicuspid and tricuspid aortic valve. Artif Organs. 2010;34( 12): 1114-20. doi: 10.1111/j.1525-1594.2009.00989.x.
4. Girdauskas E, Borger MA, Secknus MA, Gir-dauskas G, Kuntze T. Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argument. Eur J Cardiothorac Surg. 2011;39(6):809-14. doi: 10.1016/j.ejcts.2011.01.001.
5. Newby AC. Dual role of matrix metallopro-teinases (matrixins) in intimal thickening and atherosclerotic plaque rupture. Physiol Rev. 2005;85( 1 ):1 -31. doi: 10.1152/phys-rev.00048.2003.
6. Visse R, Nagase H. Matrix metalloproteinas-es and tissue inhibitors of metalloprotein-ases: structure, function, and biochemistry. Circ Res. 2003;92(8):827-39. doi: 10.1161/01.RES.0000070112.80711.3D.
7. Irtyuga OB, Gavrilyuk ND, Voronkina IV, Uspenskii VE, Malashicheva AB, Moiseeva OM. Mekhanizmy formirovaniya anevrizmy voskhodyashchego otdela aorty razlichnoi etiologii. Rossiiskii kardiologicheskii zhurnal. 2013;(1 ):14-8. doi: 10.15829/15604071-2013-1-17-19.
8. Sa MP. The aorta, the elastic tissue and cystic medial necrosis. Rev Bras Cir Cardio-vasc. 2011 ;26(1 ):III-V. doi: 10.1590/s0102-76382011000100002.
9. McKellar SH, Tester DJ, Yagubyan M, Majum-dar R, Ackerman MJ, Sundt TM 3rd. Novel NOTCH1 mutations in patients with bicuspid aortic valve disease and thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 2007;134(2): 290-6. doi: 10.1016/j.jtcvs.2007.02.041.
10. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwoger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873-926. doi: 10.1093/eurheartj/ehu281.
11. Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, Khoynezhad A, Siu SC, Verma S, Hope MD, Cameron DE, Hammer DF, Coselli JS, Moon MR, Sundt TM, Barker AJ, Markl M, Della Corte A, Michelena HI, Elefteriades JA. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg. 2018;156(2):e41-74. doi: 10.1016/j.jtcvs.2018.02.115.
12. Svensson LG, Adams DH, Bonow RO, Kou-choukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria JE, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reardon M, Reece TB, Reiss GR, Roselli EE, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic valve and ascending aorta guidelines for management and quality measures. Ann Thorac Surg. 2013;95(6 Suppl):S1-66. doi: 10.1016/j.athoracsur.2013.01.083.
13. Barili F, Pacini D, Capo A, Rasovic O, Grossi C, Alamanni F, Di Bartolomeo R, Parolari A. Does EuroSCORE II perform better than its original versions? A multicentre validation study. Eur Heart J. 2013;34(1):22-9. doi: 10.1093/eu-rheartj/ehs342.
14. Shneider YuA, Kuznetsov KV, Uzhakhov IR, Aleshkin NG. Metod plastiki i bandazhirovaniya v lechenii anevrizm voskhodyashchei aorty. Vestnik Sankt-Peterburgskoi Akademii poslediplomnogo obrazovaniya. 2009;(2):29-32.
15. Belov YuV, Stepanenko AB, Gens AP, Mkrtchyan AN, Savichev DD. Dozirovannaya rezektsiya s intimsokhranyayushchim ekzoprotezirovaniem v khirurgicheskom lechenii anevrizm voskhodyashchei aorty. Kardiologiya i serdechno-sosudistaya khirurgiya. 2010;(5):53-7.
16. Walker T, Bail DH, Gruler M, Vonthein R, Ste-ger V, Ziemer G. Unsupported reduction ascending aortoplasty: fate of diameter and of Windkessel function. Ann Thorac Surg. 2007;83(3):1047-53. doi: 10.1016/j.athoracsur.2006.10.022.
17. Cotrufo M, Della Corte A, De Santo LS, De Feo M, Covino FE, Dialetto G. Asymmetric medial degeneration of the ascending aorta in aortic valve disease: a pilot study of surgical management. J Heart Valve Dis. 2003;12(2): 127-33.
18. Feindt P, Litmathe J, Borgens A, Boeken U, Kurt M, Gams E. Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery? Eur J Cardi-othorac Surg. 2007;31(4):614-7. doi: 10.1016/j.ejcts.2007.01.028.
19. Skopin II, Farulova IYu, Tsiskaridze IM, Akimov IV, Asatryan TV, Nersesyan IL, Mu-rysova DV, Dmitrieva YuS, Tosunyan AG. Rekonstruktsiya dvustvorchatogo aortal'nogo klapana i redutsiruyushchaya voskhodyashchaya aortoplastika s naruzhnym ukrepleniem stenki voskhodyashchego otdela aorty. Grudnaya i serdechno-sosudistaya khirurgiya. 2010;3:63-7.
20. Yalcin M, Tayfur KD, Urkmez M. Should patients undergo ascending aortic replacement with concomitant cardiac surgery? Cardiovasc J Afr. 2016;27(6):338-44. doi: 10.5830/CVJA-2016-026.
21. Lim JY, Jung SH, Kim JB, Kim DK, Chung CH, Song H, Lee JW, Choo SJ. Concomitant replacement of the dilated ascending aorta during aortic valve replacement; does it increase the perioperative morbidity and mortality risks? J Card Surg. 2013;28(3):285-90. doi: 10.1111/jocs.12111.
22. Johnston LE, Downs EA, Hawkins RB, Quad-er MA, Speir AM, Rich JB, Ghanta RK, Yar-boro LT, Ailawadi G. Outcomes for low-risk surgical aortic valve replacement: A benchmark for aortic valve technology. Ann Thorac Surg. 2017;104(4):1282-8. doi: 10.1016/j.athoracsur.2017.03.053.
23. Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Am Soc Nephrol. 2010;5(6):1003-9. doi: 10.2215/CJN.06870909.
24. Bokeriya LA, Malashenkov AI, Skopin II, Kakuliya PV, Mironenko VA, Makushin AA. Khirurgicheskoe lechenie dilatirovannoi voskhodyashchei aorty pri dvukhstvorchatom aortal'nom klapane. Annaly khirurgii. 2005;(4):8-13.
25. Robicsek F, Cook JW, Reames MK Sr, Skipper ER. Size reduction ascending aortoplasty: is it dead or alive? J Thorac Cardiovasc Surg. 2004;128(4): 562-70. doi: 10.1016/j.jtcvs.2004.04.032.
26. Goksuluk D, Korkmaz S, Zararsiz G, Karaagao-glu E. easyROC: An interactive web-tool for ROC curve analysis using R language environment. The R Journal. 2016;8(2):213-26.
27. Tishkov AV, Khromov-Borisov NN, Komashnya AV, Marchenkova FYu, Semenova EM, Eyubova NI, Delakova EA, Bykhova AV. Statisticheskii analiz tablits 2 kh 2 v diagnosticheskikh issledovaniyakh. SPb.: Izdatel'stvo SPbGMU; 2013. 20 s.
28. Bauer M, Meyer R, Bauer U, Goetze N, Lange PE, Hetzer R. Relation of aortic wall alterations and ascending aorta diameter in patients with bicuspid aortic valve. Z Kardiol. 2002;91(10): 818-24. doi: 10.1007/s00392-002-0847-6.
29. Robicsek F. A new method to treat fusiform aneurysms of the ascending aorta associated with aortic valve disease: an alternative to radical resection. Ann Thorac Surg. 1982;34(1): 92-4. doi: 10.1016/s0003-4975(10)60860-0.
30. Gill M, Dunning J. Is reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta? Interact Cardiovasc Thorac Surg. 2009;9(4):693-7. doi: 10.1510/icvts.2009.213405.
31. Kiessling AH, Odwody E, Miskovic A, Stock UA, Zierer A, Moritz A. Midterm follow up in patients with reduction ascending aorto-plasty. J Cardiothorac Surg. 2014;9:120. doi: 10.1186/1749-8090-9-120.
32. Tappainer E, Fiorani V, Nocchi A, Likaj E, Mem-ishaj S, Zogno M. Safe wrapping of the borderline dilated ascending aorta during aortic valve replacement. J Cardiothorac Surg. 2007;2:15. doi: 10.1186/1749-8090-2-15.
33. Lima B, Williams JB, Bhattacharya SD, Shah AA, Andersen N, Wang A, Harrison JK, Hughes GC. Individualized thoracic aortic replacement for the aortopathy of biscuspid aortic valve disease. J Heart Valve Dis. 2011;20(4):387-95.
34. Plonek T. A meta analysis and systematic review of wrapping of the ascending aorta. J Card Surg. 2014;29(6):809-15. doi: 10.1111/jocs.12448.
35. Peterss S, Bhandari R, Rizzo JA, Fang H, Kuz-mik GA, Ziganshin BA, Elefteriades JA. The aortic root: natural history after root-sparing ascending replacement in nonsyndromic aneurysmal patients. Ann Thorac Surg. 2017;103(3):828-33. doi: 10.1016/j.athoracsur.2016.06.081.
