A case of modified aortic valve reimplantation using the «Kuban Cuff» technique in a patient with acute aortic dissection, prosthetics of the entire aortic arch, brachiocephalic trunk, left common carotid and subclavian arteries

This article illustrates a case of successful application of the Kuban Cuff technique for aortic valve (AV) reimplantation in a patient with DeBakey type I acute aortic dissection. A comprehensive surgical intervention was performed, including total aortic arch replacement and reconstruction of the brachiocephalic trunk, left common carotid, and left subclavian arteries. The operation allowed to preserve the native AV, which eliminated the need for lifelong anticoagulant therapy. Minimal complications were noted in the postoperative period, and on postoperative day 13, the patient was discharged in satisfactory condition. This case emphasizes the importance of individualized treatment strategies in acute aortic dissection and confirms the feasibility of valve-sparing procedures.

1. Malaisrie S. C., Szeto W. Y., Halas M. et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. The Journal of thoracic and cardiovascular surgery. 2021;162(3):735–758.e2. https://doi.org/10.1016/j.jtcvs.2021.04.053.

2. David T. E., Feindel C. M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. The Journal of thoracic and cardiovascular surgery. 1992;103(4):617–622.

3. Boldyrev S., Kaleda V., Barbukhatty K. Aortic valve reimplantation using Kuban Cuff modification in a patient with acute type A aortic dissection and aortic valve insufficiency. Ann Cardiothorac Surg. 2016;5(4):404–6. https://doi.org/10.21037/acs.2016.07.03. PMID: 27563556; PMCID: PMC4973117.

4. Leshnower B. G., Myung R. J., McPherson L., Chen E. P. Midterm results of David V valve-sparing aortic root replacement in acute type A aortic dissection. The Annals of thoracic surgery. 2015;99(3):795–801. https://doi.org/10.1016/j.athoracsur.2014.08.079.

5. Mastrobuoni S., De Kerchove L., Navarra E. et al. Valve sparing-aortic root replacement with the reimplantation technique in acute type A aortic dissection. Ann Cardiothorac Surg. 2016;5(4):397–400. https://doi.org/10.21037/acs.2016.04.04. PMID: 27563554; PMCID: PMC4973131.

6. Gordeev M., Uspenskiy V., Kim G. et al. Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2016;20(2):35–43. (In Russ.). https://doi.org/10.21688-1681-3472-2016-2-35-43.

7. Shrestha M., Baraki H., Maeding I. et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg. 2012; 41(1):56–61;discussion 61–2. https://doi.org/10.1016/j.ejcts.2011.04.012.PMID: 21632258; PMCID: PMC3241084.