Choosing the best myocardial revascularization method when performing ross procedure in patients with aortic diseases and coronary artery disease

Aim. The article compares long-term outcomes after Ross procedure in patients with combined coronary arteries lesion depending on a myocardial revascularization technique: coronary angioplasty or coronary artery bypass graft surgery (CABG). Methods. This prospective randomized one-center trial included 105 patients with aortic valve stenosis and combined arteriosclerotic involvement of coronary arteries. All patients received Ross procedure and myocardial revascularization. Aortic valve stenosis combined with hemodynamically significant lesion of the coronary bed served as the criteria of entry in the trial. A comparative analysis of the results in the immediate postoperative period and during 1-year follow-up was carried out. Results. The study revealed statistically significant differences in the survival rate (p = 0.024). In the CABG + Ross procedure group, the 1-year survival rate was 77 % [66; 89], which was considerably lower than that in the group with transluminal coronary angioplasty and Ross procedure - 92 % [85; 99]. Mortality in the groups under study predominantly occurred during the 1st postoperative month. In the CABG + Ross procedure group mortality was mostly recorded during the intervention and at 13th postoperative day. In the group with transluminal coronary angioplasty and Ross procedure fatal cases tended to happen at the 6th to 18th day after the intervention. Conclusion. The study was the first to show the advantage of 1 -year lethality results in the percutaneous transluminal coronary angioplasty + Ross procedure group as compared to the CABG + Ross procedure group. Nevertheless, it should be noted that one-stage aortic stenosis repair and CABG is a conventional option. In this case, a multimodality approach could be recommended for taking an optimal decision.