METHOD FOR STABILIZING MODIFIED PULMONARY ALLOGRAFT IN ROOT AND ASCENDING AORTIC REPLACEMENT IN ADULTS Russian patent published in 2025 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiac surgery. In patients with congenital and acquired pathology of aortic root and diameter of fibrous ring of aortic valve not more than 27 mm, excision of aortic valve cusps is performed. Diameter of the annulus fibrosus is measured intraoperatively with Hegar dilators. Coronary artery orifices are cut out on the sites, the remains of Valsalva sinuses are resected, and the aortic root is separated. 6 U-sutures are stitched along the line of the functional fibrous ring with a polyester suture with PTFE gaskets, with a stick-out from the inside to the outside. Sutures are arranged 3 in Valsalva sinuses and 3 in inferior points of commissural rods in a projection of a functional fibrous ring of the aortic valve so that the suture line is a circle in one plane. Allograft is measured at the following levels: the height of the pulmonary allograft, the diameter of the sinuses of the pulmonary allograft, the distance from the sinotubular junction to the piercing line on the proximal piercing cuff. Thereafter, the proximal cuff is sutured with three polypropylene guide sutures in the middle. Then guide sutures are sutured along line of anatomical fibrous ring of aortic valve directly above previously sutured separate U-sutures. After tying the guide sutures, the allograft is immersed into the left ventricular cavity and the proximal cuff of one of the polypropylene guide sutures is sutured with a continuous blanket suture at the level of each sinus. Vascular graft size is selected taking into account the size of aortic root; the length of the vascular prosthesis at the level of the proximal portion is selected taking into account the measurements made on the allograft so that the levels of the sinotubular junction of the allograft and the vascular prosthesis coincide. Vascular prosthesis is sutured with polyester sutures previously sutured through a fibrous ring, wherein suturing of each U-suture on the vascular prosthesis is performed observing the orientation of the sutured sutures. Vascular prosthesis is immersed into the aortic root and the sutures are tightened. Further, the allograft is inverted from the left ventricular cavity. Allograft is filled with normal saline to assess congruence with the vascular prosthesis and to select a place for coronary artery reimplantation. After selecting the place of reimplantation of coronary sites, reimplantation of coronary arteries is performed with polypropylene suture, continuous blanket suture. After the coronary artery reimplantation is completed, the allograft is re-filled with normal saline while controlling the anastomosis zones. Distal anastomosis with the aorta is formed by creating a single suture between the aortic wall, the allograft wall and the vascular prosthesis with a continuous blanket suture. After prevention of air embolism, the aorta clamp is removed.

EFFECT: method enables stabilizing the modified pulmonary allograft in root and ascending aortic replacement in adults, creating the root and ascending aortic anatomy most closely approximated to the normal anatomy.

2 cl, 3 dwg, 3 ex