The abstract of the Doctor of Philosophy (PhD) dissertation in medical sciences by Turaev Bobur Batir ugli, titled "Results of surgical treatment of coarctation of the aorta in patients of various age groups" in the specialty 14.00.34 – Cardiovascular surgery, is prepared for defense and includes the following key information:
Aim and Object of the Study
The main goal is to improve the surgical treatment of patients with coarctation of the aorta by applying optimal surgical methods depending on the patient's age category.
The study includes data from 120 patients operated on between 2013 and 2023 at the Center named after Academician V. Vakhidov, the clinic of the Tashkent Pediatric Medical Institute, and the Okayama University Hospital (Japan).
Patients were divided into four age groups: under 1 year (38.3%), 1–3 years (12.5%), 3–10 years (20.8%), and older than 10 years (28.3%).
The surgical methods used were: resection with end-to-end anastomosis (22.5%), patch aortoplasty (43.3%), resection with extended end-to-end anastomosis (29.2%), and prosthetic grafting (5%).
Scientific Novelty and Discoveries
It was proven that the safest and most effective method for young patients (under 1 year) is "resection with extended end-to-end anastomosis," as this method showed the lowest rate of recoarctation (re-narrowing) at 23%.
It was found that in older patients, due to the decreased elasticity of the aortic wall, the use of "patch aortoplasty" is accompanied by fewer complications, while for long-segment and recurrent cases, an interposition conduit (prosthesis) is recommended as the most reliable method.
Independent predictors leading to a decrease in left ventricular function in young children (observed in 26% of cases) were identified as the Z-score of the aortic isthmus diameter, aortic arch hypoplasia, and the degree of mitral regurgitation.
It was proven that postoperative re-narrowing (recoarctation) is directly related to the degree of aortic arch hypoplasia and an incorrectly chosen surgical method. Specifically, the frequency of reoperations reached up to 55% in patients with arch hypoplasia.
It was substantiated that failing to treat aortic coarctation surgically in a timely manner leads to severe complications such as ascending aortic dilatation (in 47.8% of patients), aortic regurgitation, and arterial hypertension.
Practical Significance and Medical Implementation
An algorithm for accurately planning the type of operation was developed by evaluating the morphology of aortic segments based on MSCT scans and Z-scores.
The scientific recommendations of the study have been implemented into the clinical practice of pediatric multidisciplinary medical centers in the Samarkand and Fergana regions.
As a result of this optimized strategy, the average hospital stay for patients was reduced from 8 to 6 days, and intensive care time was reduced by 1 day, achieving significant economic savings in the healthcare system (cost savings per patient).