misssМинимально инвазивная сердечно-сосудистая хирургияMinimally Invasive Cardiovascular Surgery3033-54263033-5434ФГБУ «НМИЦ хирургии им. А.В. Вишневского» Минздрава Россииmisss-119Research ArticleОБЗОРЫREVIEWSМинимально инвазивный подход в хирургии корня аорты: особенности становления, современные реалии и будущие перспективы (reprint)Minimally invasive aortic root surgery: evolution, current practice, and future perspectives (reprint)https://orcid.org/0000-0002-0958-7835КараджаА. В.KaradzhaAnastasia V.

Караджа Анастасия Вадимовна – младший научный сотрудник отдела новых хирургических технологий

630055, г. Новосибирск, ул. Речкуновская, 15

Anastasia V. Karadzha – MD, Research Assistant, Department of Novel Surgical Technologies E. Meshalkin National Medical Research Centre

15, Rechkunovskaya Street, Novosibirsk, 630055

nastasiiakaradzha@gmail.comhttps://orcid.org/0000-0002-8832-2447ШарифулинР. М.SharifulinRavil M.

Шарифулин Равиль Махарамович –к.м.н., врач сердечно­сосудистый хирург отделения приобретенных пороков сердца 

630055, г. Новосибирск, ул. Речкуновская, 15

Ravil M. Sharifulin – MD, PhD, Cardiovascular Surgeon, Department of Acquired Heart Diseases, E. Meshalkin National Medical Research Centre

15, Rechkunovskaya Street, Novosibirsk, 630055

https://orcid.org/0000-0003-4625-4631Богачев-ПрокофьевА. В.Bogachev-ProkofievAlexander V.

Богачев­-Прокофьев Александр Владимирович – д.м.н., директор института патологии кровообращения

630055, г. Новосибирск, ул. Речкуновская, 15 

Alexander V. Bogachev­Prokofiev – MD, PhD, Director, Institute of Circulatory Pathology, E. Meshalkin National Medical Research Centre

15, Rechkunovskaya Street, Novosibirsk, 630055

https://orcid.org/0000-0001-9818-8678ЧернявскийА. М.ChernyavskiyAlexander M.

Чернявский Александр Михайлович – д.м.н., профессор, член­-корреспондент РАН, генеральный директор

630055, г. Новосибирск, ул. Речкуновская, 15 

Alexander M. Chernyavskiy – MD, PhD, Professor, Corresponding Member of Russian Academy of Sciences, Director General, E. Meshalkin National Medical Research Centre

15, Rechkunovskaya Street, Novosibirsk, 630055

ФГБУ «Национальный медицинский исследовательский центр им. акад. Е.Н. Мешалкина»РоссияSBI «Federal Center for Cardiovascular Surgery named after S.G. Sukhanov» Ministry of Health of RussiaRussian Federation202528112025137995Copyright © Караджа А.В., Шарифулин Р.М., Богачев-Прокофьев А.В., Чернявский А.М., 20252025Караджа А.В., Шарифулин Р.М., Богачев-Прокофьев А.В., Чернявский А.М.Karadzha A.V., Sharifulin R.M., Bogachev-Prokofiev A.V., Chernyavskiy A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://misss.elpub.ru/jour/article/view/119Цель исследования

Цель исследования: провести систематический анализ современных минимально инвазивных методик хирургии корня аорты, оценив их безопасность, эффективность и перспективы внедрения в клиническую практику.

Материалы и методы

Материалы и методы: проведен аналитический обзор литературы с использованием международных (Medline, Google Scholar, Cochrane Library) и российских («eLibrary.Ru») баз данных. Исследованы исторические аспекты, технические особенности операций через частичную верхнюю мини-стернотомию и правостороннюю мини-торакотомию, а также их клинические результаты.

Результаты

Результаты: минимально инвазивные методики демонстрируют: сопоставимые со стернотомией показатели безопасности (летальность 1,2% vs 1,8%) и эффективности, меньшую интраоперационную кровопотерю (в среднем на 200-300 мл), сокращение времени восстановления (госпитализация 5-7 vs 8-12 дней), более низкую частоту инфекционных осложнений (1,5% vs 4,2%), отличный косметический результат.

Заключение

Заключение: несмотря на преимущества, уровень доказательности современных исследований остается низким. Для перехода минимально инвазивных методик в категорию золотого стандарта при хирургии корня аорты необходимы многоцентровые рандомизированные исследования с длительным периодом наблюдения.

Objective

Objective: to perform a systematic evaluation of current evidence and future perspectives of minimally invasive approaches in aortic root surgery by analyzing their safety, efficacy, and clinical outcomes compared to conventional median sternotomy.

Materials and methods

Materials and methods: а comprehensive analytical literature review was conducted using international databases (Medline, Google Scholar, Cochrane Library) and Russian scientific sources (eLibrary.Ru). The analysis included historical aspects, technical features of operations performed through partial upper ministernotomy and right minithoracotomy, and their clinical outcomes.

Results

Results: minimally invasive techniques demonstrate comparable safety and efficacy to sternotomy, with advantages including reduced intraoperative blood loss (mean 250±50 mL vs 450±100 mL), shorter recovery time (5.2±1.3 vs 7.8±2.1 days), lower infection rates (1.8% vs 4.5%), and excellent cosmetic results.

Conclusion

Conclusion: despite these advantages, the level of evidence in current studies remains low. Multicenter randomized trials with long-term followup are needed to establish minimally invasive techniques as the «gold standard» in aortic root surgery.

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The authors declare that there are no conflicts of interest present.