PULMONARY ALLOGRAFT IN AORTIC POSITION. IMPLANTATION TECHNIQUES, CAUSE OF EARLY AND LATE DYSFUNCTION. A SYSTEMATIC REVIEW

Nuzhdin Mikhail D., Komarov Roman N., Nadin Ilia S., Stroganov Igor A., Fokin Aleksey A.

Background. Aortic root surgery currently includes a wide range of operations, involving the use of various types of valve replacements, as well as valve-sparing operations. The use of pulmonary allograft is poorly covered in the world literature; immediate and long-term results, along with the causes of dysfunction, are not systematized. Objective. To systematize the world experience of using pulmonary allograft in aortic root surgery. Methods. The systematic review was conducted according to PRISMA criteria. The following terms were used as search queries in the databases: ((pulmonary homograft) OR (pulmonary allograft) AND (aortic valve replacement) NOT ((autograft) OR (Ross)). The available databases PubMed (NCBI) were used to conduct the search. Cohrane Library, Web of Sciences (Clarivate), Google Scholar, and the Consensus neural network. Results. After conducting a search according to inclusion and exclusion criteria, involving 3 specialists, 9 publications from 1990 to 2023 were selected for analysis. In total, world experience with the use of pulmonary allograft includes 463 operations. According to available publications, pulmonary allograft was implanted using three different techniques, two of which - subcoronary and cylindrical - are currently practically not used. The predominant causes of early mortality are allograft-unrelated complications, while in the long-term period, allograft degeneration was the main reason for reoperations. Conclusion. Pulmonary allograft implantation using subcoronary or cylindrical techniques does not achieve good immediate and long-term results. Analysis of the patient population indicates that there are no criteria for selecting patients for this operation. Analysis of immediate mortality and early reoperations indicates the lack of a unified approach to indications for surgery and technical errors during implantation. The period of observation of patients, as well as the lack of a unified approach to recording end points, a significant difference in the implantation technique does not allow us to draw conclusions about the long-term performance of the pulmonary allograft in the aortic position.

Keywords:pulmonary allografts, aortic root.