Russian conduit II: rationale for the use of a new aortic root prosthesis and first case-report

Introduction. Aortic root surgery continues to improve. Both linear valve-containing and anatomic (so-called Valsalva grafts) conduits are used for aortic root replacement. However, there is no clear opinion about the importance of using anatomical valve-containing conduits. The answer to this question can be obtained by comparing the transvalvular hemodynamics of a linear conduit with the transvalvular hemodynamics of the native aortic root. Research in this area will help to find the characteristics that a new valve-containing conduit should possess to provide optimal hemodynamics.Objective. To demonstrate the method of aortic root structures prosthetics with imitation of its natural geometry, to report on the advantages of such intervention from the position of transvalvular hemodynamics.Material and Methods. An experimental study of transvalvular hemodynamics in the prosthesis “Russian Conduit I” of linear design with autopericardial flaps sewn into it was performed. The results were compared with the reference hemodynamics in the native aortic root with sewn-in flaps of the same shape as in the studied conduit. The results of the study showed that the natural geometry of the aortic root significantly affects transvalvular hemodynamics, which is expressed in smaller transvalvular gradients, lower energy losses at the opening and closing of the flaps, and larger opening area.Results. We extrapolated the experimental data to the clinical results of similar operations in comparable groups. We studied the results of the operation with the use of the Russian Conduit prosthesis. The operation with the aortic root preservation was symmetrical neocuspidization. According to the results of the study it was demonstrated that preservation of native aortic root gives better transvalvular hemodynamics, which significantly affects the reverse remodeling of the left ventricle in the mid-term period. With this in mind, it is concluded that it is necessary to preserve the geometry of the aortic root during interventions for its prosthesis with a valve-containing conduit. This paper presents a clinical case of a new aortic root prosthesis “Russian Conduit II”. It was used for aortic root reconstruction with restoration of the locking function of the native aortic valve. The description of the surgical technique, immediate results, and the possibilities of similar surgical intervention are described in detail.Conclusion. There are reasons to believe that the use of the developed prosthesis in aortic root surgeries can give hemodynamic results comparable with native valve, and the operation itself has a potential for high reproducibility and standardization of surgical technique, which will expand its application.