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Brega C, Albertini A. Aortic Root Surgery in Adults: An Unsolved Problem. AORTA (STAMFORD, CONN.) 2023; 11:29-35. [PMID: 36848909 PMCID: PMC9970757 DOI: 10.1055/s-0042-1757949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Nowadays, despite the rapid advancements in interventional cardiology, open surgery still deals with aortic root diseases, to assure the best "ad hoc" treatment. In case of middle-aged adult patients, the optimal operation still represents a matter of debate. A review of the last 10-year literature was conducted, focusing on patients below 65 to 70 years of age. Because of the small sample and the heterogeneity of the papers, no metanalysis was possible. Bentall-de Bono procedure, valve sparing, and Ross operations are the surgical options currently available. The main issues in the Bentall - de Bono operation are lifelong anticoagulation therapy and cavitation in case of mechanical prosthesis implantation and structural valve degeneration in case of biological Bentall. As transcatheter procedures are currently performed as valve in valve, biological prosthesis may be preferable, if the diameter may prevent postoperative high gradients. Conservative techniques, such as remodeling and reimplantation, preferred in the young, guarantee physiologic aortic root dynamics and impose surgical analysis of the aortic root structures to get a durable result. The Ross operation, which shows excellent performance, involves autologous pulmonary valve implantation and is performed only in experienced and high-volume centers. Due to its technical difficulty, it requires a steep learning curve and presents some limitations in specific aortic valve diseases. All three have advantages and downsides, and no ideal solution has still been reported.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy,Address for correspondence Carlotta Brega, MD Maria Cecilia Hospital, GVM Care and ResearchVia Corriera 1, 48033 Cotignola, RAItaly
| | - Alberto Albertini
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy
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Ikeno Y, Motoki T, Kurushima A, Fukumura Y. Reoperative Aortic Valve Replacement After Bio-Bentall using a Double Sewing Ring Technique. Eur J Cardiothorac Surg 2022; 62:6677659. [PMID: 36029246 DOI: 10.1093/ejcts/ezac428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/14/2022] [Indexed: 11/13/2022] Open
Abstract
We report an 89-year-old hemodialysis patient with a structural valve deterioration following a Bentall-de Bono operation with a tissue valve using the double sewing ring technique. The bioprosthesis was extracted easily, and the aortic valve replacement was performed without any complications in a high-risk patient. This procedure may be feasible given the prospects of reoperation.
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Affiliation(s)
- Yuki Ikeno
- Department of Cardiovascular Surgery, Japanese Red Cross Tokushima Hospital, Komatsushima, Tokushima, Japan
| | - Tatsuo Motoki
- Department of Cardiovascular Surgery, Japanese Red Cross Tokushima Hospital, Komatsushima, Tokushima, Japan
| | - Atsushi Kurushima
- Department of Cardiovascular Surgery, Japanese Red Cross Tokushima Hospital, Komatsushima, Tokushima, Japan
| | - Yoshiaki Fukumura
- Department of Cardiovascular Surgery, Japanese Red Cross Tokushima Hospital, Komatsushima, Tokushima, Japan
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Hamasaki A, Morita K, Ikeda M, Murakami H, Niinami H. Trans‐cuff leakage in bio‐Bentall operation. J Card Surg 2022; 37:1056-1058. [DOI: 10.1111/jocs.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Azumi Hamasaki
- Department of Cardiovascular SurgeryTokyo Women's Medical UniversityShinjukuJapan
| | - Kozo Morita
- Department of Cardiovascular SurgeryTokyo Women's Medical UniversityShinjukuJapan
| | - Masahiro Ikeda
- Department of Cardiovascular SurgeryTokyo Women's Medical UniversityShinjukuJapan
| | - Hironori Murakami
- Department of Cardiovascular SurgeryTokyo Women's Medical UniversityShinjukuJapan
| | - Hiroshi Niinami
- Department of Cardiovascular SurgeryTokyo Women's Medical UniversityShinjukuJapan
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Mutsuga M, Usui A. "Double Cuff" Technique for Modified Bentall Procedure. Heart Lung Circ 2021; 30:e109-e111. [PMID: 34083152 DOI: 10.1016/j.hlc.2021.05.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
The combination of interrupted and running sutures was initially introduced as a tandem suture line to improve haemostasis in the modified Bentall procedure. These techniques basically consist of two suturing techniques. This paper reports the "Double Cuff" technique, which uses only one interrupted suture with a double-folded layer between the aortic remnant wall of Valsalva and the aortic ring and a double-folded layer on the composite graft side to ensure absolute proximal annular haemostasis. The proximal side of the composite graft is made by fashioning a double layer, in which the graft is everted inside and sutured with the prosthetic valve. The "Double Cuff" technique is a simple, reproducible and durable method for ensuring haemostasis and should be considered as a supplementary procedure for proximal anastomosis.
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Affiliation(s)
- Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Scaffa R, Weltert L, Salica A, De Paulis R. The Skirt and Collar of The Valsalva Graft: One Dress Fits All. Surg Technol Int 2021; 38:271-277. [PMID: 33724434 DOI: 10.52198/21.sti.38.cv1390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the original pre-formed Valsalva graft, the skirt is the defining feature. It is a self-expanding portion, obtained by 90° rotation of the Dacron fabric corrugation with respect to the rest of the graft. Due to this manufacturing feature, the skirt length is equal to the graft diameter and, once pressurized, it expands by 25-30% (up to 10 mm) from the nominal size. Proximal to this bulged portion, a small collar completes the prosthesis. By virtue of this anatomical design, the Valsalva graft is recommended for most aortic root surgeries including valve-sparing and Bentall procedures. The skirt, by recreating the pseudo-sinuses, represents the key feature of the graft when used for aortic valve-sparing procedures (remodeling and reimplantation). However, in the Bentall procedure, the graft collar is an important feature because it is useful to attach the Valsalva graft to the valve prosthesis sewing ring when making a valved conduit. Moreover, once the graft is pressurized, the whole volume of the skirt better accommodates the struts and the leaflets of biological and mechanical prostheses. Furthermore, the expanded skirt reduces the distance and the tension on the coronary button anastomosis, increasing safety and possibly reducing complication rates. This review demonstrates the versatility of the Valsalva graft in various scenarios of aortic root surgery, with special emphasis on different uses of the skirt and the collar.
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Affiliation(s)
- Raffaele Scaffa
- Department of Cardiac Surgery, European Hospital, Rome, Italy
- Division of Cardiac Surgery, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Andrea Salica
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy
- UniCamillus, International Medical University, Rome, Italy
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Song L, He G, Imin E, Tao C, Xu M, Wang B, Li X, Tao L. ''Chimney'' Bentall Procedure in the Small Aortic Root After Prior Aortic Valve Operations. Ann Thorac Surg 2020; 110:e241-e243. [PMID: 32213309 DOI: 10.1016/j.athoracsur.2020.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
The ''Chimney'' Bentall procedure using a self-assembled valve composite graft has been performed in 24 patients with a small aortic root or annulus after previous valve replacement in our center. The mean diameter of the aortic annulus was 19.58 ± 1.8 mm. During the procedure, the mean size of the implanted aortic valve prosthesis was 22.75 ± 1.78 mm. The mean gradient across the aortic valve prosthesis was 11.17 ± 2.24 mm Hg. This technique allows for the implantation of a larger prosthesis in patients with a small aortic annulus or root after previous aortic valve operation and results in good postoperative hemodynamic characteristics and early clinical results.
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Affiliation(s)
- Laichun Song
- Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, P.R. China; Affiliated Wuhan University of Science and Technology, Wuhan, P.R. China
| | - Guibao He
- Department of Cardiac Surgery, Xinjiang Cardiovascular and Cerebrovascular Disease Hospital, Urumqi, P.R. China
| | - Elyas Imin
- Department of Cardiac Surgery, Xinjiang Cardiovascular and Cerebrovascular Disease Hospital, Urumqi, P.R. China
| | - Chao Tao
- Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, P.R. China
| | - Ming Xu
- Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, P.R. China
| | - Bo Wang
- Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, P.R. China
| | - Xiaoyong Li
- Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, P.R. China
| | - Liang Tao
- Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, P.R. China; Affiliated Wuhan University of Science and Technology, Wuhan, P.R. China.
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Podesser BK, De Paulis R. Implantability of a novel, pre-assembled aortic valved conduit with RESILIA™ tissue. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:376-379. [PMID: 31815373 DOI: 10.23736/s0021-9509.19.11022-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Currently, the only commercial pre-assembled aortic valved conduits employ mechanical valves, requiring lifelong anticoagulation. Tissue-valved conduits that require assembly on the operating table are less standardized, require extensive experience for satisfactory results, and are limited in their longevity. The KONECT RESILIA™ Aortic Valved Conduit is a new tissue valved conduit that consists of a Carpentier-Edwards PERIMOUNT™ Magna Ease™ aortic valve stent, the novel RESILIA™ tissue leaflets, and a new DualFit sewing ring pre-assembled to a Terumo GelWeave Valsalva Graft™. RESILIA tissue is a bovine pericardial tissue that may offer superior anti-calcification properties compared to contemporary tissue valves; furthermore, it may be stored dry. METHODS We tested the handling and implantability of this new aortic valved conduit in 8 human cadaver hearts, as well as the valve removal potential without detaching the coronary ostia. RESULTS The KONECT RESILIA aortic valved conduit's handling and implantability was uniformly satisfactory. The valve inside the conduit could be easily surgically extracted, leaving the conduit and coronary ostia intact. CONCLUSIONS We found this first evaluation of the KONECT RESILIA Aortic Valved Conduit to be that it handled well and was easily implantable and extractable in a human cadaver model.
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Affiliation(s)
- Bruno K Podesser
- Center for Biomedical Research, Medical University of Vienna and Karl Landsteiner University St. Poelten, Vienna, Austria -
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital of Rome, Rome, Italy
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Mini-Bentall: An Interesting Approach for Selected Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:41-45. [PMID: 28129319 DOI: 10.1097/imi.0000000000000337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Minimally invasive surgery through an upper hemisternotomy for aortic valve replacement has become the routine approach with excellent results. Actually, the same minimally invasive access is used for complex ascending aorta procedures only in few centers. We report our experience with minimally invasive approach for aortic valve and ascending aorta replacement using Bentall technique. METHODS From January 2010 to November 2015, a total of 238 patients received ascending aorta and aortic valve replacement using Bentall De Bono procedure at our institution. Low- and intermediate-risk patients underwent elective surgery with a minimally invasive approach. The "J"-shaped partial upper sternotomy was performed through a 6-cm skin incision from the notch to the third right intercostal space. Patients who had previous cardiac surgery or affected by active endocarditis were excluded. The study included 53 patients, 44 male (83 %) with a median age of 63 years [interquartile range (IQR), 51-73 years]. A bicuspid aortic valve was diagnosed in 27 patients (51%). RESULTS A biological Bentall using a pericardial Mitroflow or Crown bioprosthesis implanted in a Valsalva graft was performed in 49 patents. The remaining four patients were treated with a traditional mechanical conduit. Median cardiopulmonary bypass time and median cross-clamp time were respectively 84 (IQR, 75-103) minutes and 73 (IQR, 64-89) minutes. Hospital mortality was zero as well as 30-day mortality. Median intensive care unit and hospital stay were 1.9 and 8 days, respectively. The study population compared with patients treated with standard full sternotomy and similar preoperative characteristics showed similar results in terms of postoperative outcomes with a slightly superiority of minimally invasive group mainly regarding operative times, incidence of atrial fibrillation, and postoperative ventilation times. CONCLUSIONS A partial upper sternotomy is considered a safe option for aortic valve replacement. Our experience confirms that a minimally invasive approach using a partial upper J-shaped sternotomy can be a safe alternative approach to the standard in selected patients presenting with complex aortic root pathology.
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Mikus E, Micari A, Calvi S, Salomone M, Panzavolta M, Paris M, Del Giglio M. Mini-Bentall: An Interesting Approach for Selected Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Elisa Mikus
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | - Antonio Micari
- Cardiology, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Simone Calvi
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | | | - Marco Panzavolta
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | - Marco Paris
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
| | - Mauro Del Giglio
- Departments of Cardiovascular Surgery, Cotignola, Ravenna, Italy
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Oshima H, Abe T, Narita Y, Usui A. Non-anastomotic rupture of the Valsalva graft 6 years after undergoing the Bentall procedure. Interact Cardiovasc Thorac Surg 2016; 23:668-70. [PMID: 27324732 DOI: 10.1093/icvts/ivw195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 05/15/2016] [Indexed: 11/13/2022] Open
Abstract
A 72-year old man with an unruptured aneurysm of the right sinus of Valsalva and aortic insufficiency underwent aortic root replacement using a valved composite graft created with a 28-mm woven Dacron graft (Gelweave Valsalva™ graft, Vascutek Terumo, Renfrewshire, Scotland) and a 25-mm stented bioprosthetic aortic valve (Carpentier-Edwards PERIMOUNT pericardial bioprosthesis, Edwards Lifesciences, Irvine, CA, USA). His postoperative course was uneventful. He had undergone a follow-up CT scan once a year. Although no abnormal signs were detected 5 years after surgery, a CT scan performed in the sixth postoperative year revealed an aortic false aneurysm around the Dacron graft. The false aneurysm enlarged over time and he underwent elective surgery. Two small holes were identified in the 'sinus' portion of the Valsalva graft. The holes were located at the site of the vascular prosthesis corresponding to the level sandwiched between the strut of the bioprosthetic aortic valve and the main pulmonary artery. Therefore, the vascular prosthesis could be exposed to persistent pulsatile contact with the strut resulting from pulsation of the pulmonary artery. This contact/friction might result in fraying of the fabric of the vascular prosthesis, finally leading to non-anastomotic rupture of the Valsalva graft.
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Affiliation(s)
- Hideki Oshima
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomonobu Abe
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Alameddine AK, Alimov VK, Pluchino F. A Technique for Avoiding Patient-Prosthesis Mismatch in the Small Aortic Root. J Card Surg 2016; 31:309-10. [PMID: 27018394 DOI: 10.1111/jocs.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the small aortic root, extremely weakened tissue and extensive calcification predispose toward the implantation of small prostheses, anastomotic bleeding, and paravalvular leaks. We describe a procedure in which a "homemade" composite mechanical prosthesis-conduit is implanted in a supra-annular position in two patients with a small aortic root. This technique facilitates the placement of a larger prosthesis, thus avoiding patient-prosthesis mismatch. doi: 10.1111/jocs.12741 (J Card Surg 2016;31:309-310).
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Affiliation(s)
- Abdallah K Alameddine
- Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts.,Tufts School of Medicine, Boston, Massachusetts
| | - Victor K Alimov
- Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts.,Tufts School of Medicine, Boston, Massachusetts
| | - Fabrizio Pluchino
- Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts.,Tufts School of Medicine, Boston, Massachusetts
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Aortenwurzelersatz. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-015-0031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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[A revised modified bentall's procedure using aorto-prosthetic hemostatic suture]. VOJNOSANIT PREGL 2011; 68:441-3. [PMID: 21744654 DOI: 10.2298/vsp1105441r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kim TY, Lee JM, Choi JB, Kim MH, Jo JK. Modified Bentall Operation and the Double Sewing Ring Technique -2 case reports-. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tae Yun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Jung-Moon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Jong-Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Min Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Jung-Ku Jo
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
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Tabata M, Takayama H, Bowdish ME, Smith CR, Stewart AS. Modified Bentall Operation With Bioprosthetic Valved Conduit: Columbia University Experience. Ann Thorac Surg 2009; 87:1969-70. [DOI: 10.1016/j.athoracsur.2008.09.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 08/25/2008] [Accepted: 09/19/2008] [Indexed: 10/20/2022]
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Composite freestyle stentless xenograft with Dacron graft extension for ascending aortic replacement. Ann Thorac Surg 2009; 87:1789-94. [PMID: 19463596 DOI: 10.1016/j.athoracsur.2009.03.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 03/23/2009] [Accepted: 03/25/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND The present study was undertaken to evaluate clinical, hemodynamic, and morphologic results of composite stentless xenograft with polyethylene terephthalate fiber (Dacron; DuPont, Wilmington, DE) graft extension for combined replacement of the aortic valve, root, and ascending aorta. METHODS Between 1997 and 2008, 55 consecutive patients (33 men, 71 +/- 11 years) underwent ascending aortic replacement using Medtronic Freestyle with Dacron graft extension (DuPont). Indications included aneurysm (n = 31, 56%), dissection (n = 16, 29%), and endocarditis (n = 8, 15%). Associated procedures were performed in 25 patients (46%). Preoperative logistic EuroSCORE averaged 34% +/- 28%. Mean cardiopulmonary bypass and aortic cross-clamp times were 244 +/- 134 minutes and 162 +/- 69 minutes, respectively. RESULTS Clinical follow-up was 100% complete and averaged 2 +/- 3 years. Early mortality was 0% (n = 0) in patients with a preoperative EuroSCORE of less than 20 (n = 26, mean expected mortality, 13% +/- 5%) and 31% (n = 9) in those with preoperative logistic EuroSCORE of at least 20 (n = 29, mean expected mortality, 52% +/- 28%). One- and 3-year survival rates were 83% +/- 5% and 78% +/- 7%, respectively. No major thromboembolic or spontaneous bleeding events were recorded. One patient (2%) required late reoperation for prosthetic valve endocarditis. Echocardiographic follow-up showed no valve dysfunction and low mean transvalvular gradients (7 +/- 5 mm Hg). A 64-channel computed tomographic scan was performed in 33 patients at 32.4 +/- 34 months and revealed two small pseudoaneurysms in a single patient. CONCLUSIONS Composite Freestyle with Dacron graft extension appears to be a safe option for bioprosthetic replacement of the aortic root and tubular ascending aorta. However, long-term results using this composite graft will have to be determined.
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Mandegar MH, Roshanali F. The double sewing ring technique: a not so easy reoperation! Eur J Cardiothorac Surg 2008; 34:224. [PMID: 18502658 DOI: 10.1016/j.ejcts.2008.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 02/03/2008] [Accepted: 04/14/2008] [Indexed: 11/16/2022] Open
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Usui A, Ueda Y. Biological Bentall procedure with a Valsalva graft for a small aortic root. Eur J Cardiothorac Surg 2008; 34:224-5. [PMID: 18487057 DOI: 10.1016/j.ejcts.2008.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 02/03/2008] [Accepted: 04/15/2008] [Indexed: 11/25/2022] Open
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