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Konstantinov IE, Zubritskiy A. Do we all need to learn aortic valve repair the HAART way? J Thorac Cardiovasc Surg 2024; 167:e74-e75. [PMID: 37737790 DOI: 10.1016/j.jtcvs.2023.08.034] [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: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Victoria, Australia
| | - Alexey Zubritskiy
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
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2
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Arabkhani B, Sandker SC, Braun J, Hjortnaes J, van Brakel TJ, Koolbergen DR, Klautz RJM, Hazekamp MG. Aortic valve visualization and pressurization device: a novel device for intraoperative evaluation of aortic valve repair procedures. Eur J Cardiothorac Surg 2023; 64:ezad291. [PMID: 37610333 PMCID: PMC10903180 DOI: 10.1093/ejcts/ezad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Aortic valve repair procedures are technically challenging, and current intraoperative evaluation methods often fail to predict the final echocardiographic result. We have developed a novel intraoperative aortic valve visualization and pressurization (AVP) device, enabling valve inspection under physiological conditions, and measuring aortic valve insufficiency (AI) during cardioplegic arrest. METHODS The AVP device is attached to the (neo)aorta, after any type of aortic valve repair, while the heart is arrested. The root is pressurized (60-80 mmHg) using a saline solution and an endoscope is introduced. The valve is inspected, and the amount of valvular leakage is measured. Postoperative 'gold standard' transesophageal echocardiogram measurements of AI are performed and compared against regurgitation volume measured. RESULTS In 24 patients undergoing valve-sparing root replacement, the AVP device was used. In 22 patients, postoperative echocardiographic AI was ≤ grade 1. The median leakage was 90 ml/min, IQR 60-120 ml/min. In 3 patients, additional adjustments after visual inspection was performed. In 2 patients, with complex anatomy, the valve was replaced. In one, after evaluation with the device, there was undesirable result visually and residual AI of 330 ml/min, and in another, 260 ml/min residual AI was measured and valve restriction on visual inspection. CONCLUSIONS The novel AVP device enables intraoperative evaluation of the valve under physiological conditions, while still on arrested heart, and allows for targeted adjustments. The AVP device can be an important aid for intraoperative evaluation of the aortic valve, during valve repair and valve-sparing procedures, thereby making the operative result more predictable and the operation more efficient.
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Affiliation(s)
- Bardia Arabkhani
- Department of Cardiothoracic surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Stefan C Sandker
- Department of Cardiothoracic surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Jesper Hjortnaes
- Department of Cardiothoracic surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Dave R Koolbergen
- Department of Cardiothoracic surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
- Department of Cardiothoracic surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic surgery, Leiden University Medical Center (LUMC), Leiden, Netherlands
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Devine K, Augoustides JG. Aortic Valve Repair: The Evolving Frontiers of Aortic Annuloplasty. J Cardiothorac Vasc Anesth 2022; 36:3999-4000. [PMID: 35989242 DOI: 10.1053/j.jvca.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Katelyn Devine
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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4
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Chauvette V, Kluin J, de Kerchove L, El Khoury G, Schäfers HJ, Lansac E, El-Hamamsy I. Outcomes of Valve-Sparing Surgery in Heritable Aortic Disorders: Results from the AVIATOR Registry. Eur J Cardiothorac Surg 2022; 62:6653300. [PMID: 35916717 DOI: 10.1093/ejcts/ezac366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/23/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Root reimplantation has been the favored approach for patients with heritable aortic disorder (HAD) requiring valve-sparring root replacement (VSRR). In the past few years, root remodelling with annuloplasty has emerged as an alternative to root reimplantation in the general population. The aim of this study was to examine the late outcomes of patients with HAD undergoing VSRR and compare different techniques. METHODS Using the AVIATOR registry, data were collected from 5 North American and European centers. Patients were divided in 4 groups according to the technique of valve-sparing used (root reimplantation, root remodelling with ring annuloplasty, root remodelling with suture annuloplasty and root remodelling alone). The primary end-points were freedom from aortic regurgitation (AR) ≥2 and freedom from reintervention on the aortic valve. Secondary end-points were survival and changes in annular dimensions over time. RESULTS A total of 237 patients were included in the study (reimplantation= 100, remodelling + ring annuloplasty= 76, remodelling + suture annuloplasty= 34, remodelling alone= 27). The majority of patients had Marfan syndrome (82%). Preoperative AR ≥ 2 was present in 41% of the patients. Operative mortality was 0.4% (n = 1). No differences were found between techniques in terms of postoperative AR ≥ 2 (p = 0.58), reintervention (p = 0.52) and survival (p = 0.59). Changes in aortic annulus dimension were significantly different at 10 years (p < 0.05), a difference that started to emerge 4 after years surgery. CONCLUSIONS Overall, VSRR are safe and durable procedures in patients with HAD. Nevertheless, root remodelling alone is associated with late annular dilatation. Addition of an annuloplasty, however, results in similar freedom from AR, reintervention, survival, and changes in annulus size compared to reimplantation.
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Affiliation(s)
- Vincent Chauvette
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montreal, Montreal, Canada
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Laurent de Kerchove
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States
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Daly A, Roselli EE. The surgical delicacy of personalized, lifelong care: Commentary on early results from the CAVIAAR study. Eur J Cardiothorac Surg 2022; 62:6637514. [PMID: 35809066 DOI: 10.1093/ejcts/ezac351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adam Daly
- Aortic Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Aortic Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Early results after aortic annuloplasty with a complete external Dacron band. Gen Thorac Cardiovasc Surg 2021; 70:329-336. [PMID: 34542798 PMCID: PMC8930909 DOI: 10.1007/s11748-021-01695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/04/2021] [Indexed: 10/29/2022]
Abstract
OBJECTIVE This study evaluates the early results of our initial experience with aortic annuloplasty using a complete external Dacron band in the setting of type Ic or type II aortic regurgitation (AR). METHODS From May 2017 to August 2019, 16 patients (88% bicuspid aortic valves, no patients with connective tissue disorders) underwent aortic annuloplasty with an external complete Dacron band. Clinical and echocardiographic follow-up was 100% complete. Clinical and echocardiographic follow-up averaged 24.4 ± 9.3 and 15.1 ± 8.3 months, respectively. RESULTS Mean cardiopulmonary and cross-clamp times were 105 ± 15 (72-127) and 86 ± 15 (51-113) min, respectively. Early and late mortality was 0%, with no incidents of endocarditis or cerebrovascular events during the follow-up. Two patients were re-operated during the follow-up, one due recurrent aortic regurgitation (12 months after the first operation) yielding a freedom from reoperation due to AR at 1 year and 3 years of 100% ± 0% and 93.3% ± 5.7%, respectively. Based on the latest echocardiogram, five patients had either none or trivial AR, six had mild AR, and three had mild-to-moderate AR. CONCLUSIONS The early clinical and echocardiographic results after using a complete external Dacron band are promising; however, more data and longer follow-up are needed to determine its role in annular management during aortic valve repair.
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Papakonstantinou NA, Kogerakis N, Kantidakis G, Athanasopoulos G, Stavridis GT. A modern approach to aortic valve insufficiency: Aortic root restoration via HAART 300 internal annuloplasty ring. J Card Surg 2021; 36:4189-4195. [PMID: 34448500 DOI: 10.1111/jocs.15947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY HAART 300 is an internal geometric annuloplasty ring. The safety and efficacy of this novel device in aortic valve (AV) repair in a single referral center are reported. METHODS Twenty patients with trileaflet AV insufficiency with ascending aorta and/or aortic root enlargement were included. Subannular implantation was performed to correct annular dilatation, whereas concomitant leaflet repair was performed whenever required. All but two patients also received ascending aorta replacement, whereas selective sinus replacement was performed in all but five patients. RESULTS Follow-up was for a maximum of 3.8 years and a mean of 2.2 years. Mean age was 54.2 years old. Moderate to severe preoperative AV insufficiency was noted in 75% of patients, whereas 70% of them had an ascending aorta over 45 mm. One patient was lost from follow-up. Overall mortality as well as major complication rates were zero. Early postoperatively, no more than mild AV regurgitation was detected, whereas only one patient appeared with moderate AV regurgitation during our 2.2-year follow-up. New York Heart Association class was also significantly lower compared to preoperative values and valve gradients remained low at last follow-up. CONCLUSIONS Geometric ring annuloplasty is a safe and effective valve sparing approach to deal with AV insufficiency contributing to overall root reconstruction. Short-term results are excellent rendering this easily reproducible and versatile method very attractive.
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Affiliation(s)
- Nikolaos A Papakonstantinou
- 3rd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.,2nd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nektarios Kogerakis
- 2nd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Georgios Kantidakis
- 3rd Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
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Holst T, Petersen J, Sinning C, Reichenspurner H, Girdauskas E. Aortic Valve Repair in Annular Dilatation: External Versus Internal Suture Annuloplasty. Ann Thorac Surg 2021; 113:2036-2044. [PMID: 34237289 DOI: 10.1016/j.athoracsur.2021.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/09/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Annuloplasty is essential in aortic valve repair. The most appropriate technique is, however, highly controversial. We aimed to evaluate changes in postoperative annulus diameter on serial echocardiography after external and internal suture annuloplasty. METHODS We retrospectively reviewed serial transthoracic echocardiography of consecutive patients from our institutional aortic valve repair registry who had received suture annuloplasty. Mid-systolic annulus diameter was measured on parasternal long-axis view preoperatively, at discharge, 3-6 months, 1, 2 and 3 years postoperatively. Primary endpoint was the prevalence of annulus re-dilatation. Secondary endpoints were the correlation between annulus re-dilatation and (1) external vs. internal technique and (2) reoccurrence of aortic insufficiency (AI)≥2. RESULTS A total of 70 patients (mean age 43±13 years, 91% male) underwent aortic valve repair including external (n=27) or internal (n=43) suture annuloplasty between February 2016 and November 2019. Mean follow-up was 17±11 (3-50) months. Mean preoperative annulus diameter of 29.7±2.8 (23.8-37.8) mm was significantly reduced to 22.7±2.9 (16.7-31.7) mm, p<0.001 at discharge and increased to 23.8±2.3 (20.9-27.0) mm, p=0.037 during follow-up. The mild increase in postoperative annulus diameter did not correlate with the reoccurrence of AI≥2. Preoperative annulus was significantly larger in the external group (external: 30.6±3.2 mm; internal: 29.1±2.5 mm; p=0.032). However, we found no significant difference in postoperative annulus increase rate between both techniques. CONCLUSIONS Although mild, a significant continuous increase of annulus diameter after suture annuloplasty was seen which did not correlate with the reoccurrence of AI≥2 at mid-term follow-up. Annulus re-dilatation was comparable between external and internal technique.
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Affiliation(s)
- Theresa Holst
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany
| | - Christoph Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany; Department of Cardiothoracic Surgery, Augsburg University Hospital, Germany.
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Tamer S, Mastrobuoni S, van Dyck M, Navarra E, Bollen X, Poncelet A, Noirhomme P, Astarci P, El Khoury G, de Kerchove L. Free margin length and geometric height in aortic root dilatation and leaflet prolapse: implications for aortic valve repair surgery. Eur J Cardiothorac Surg 2021; 57:124-132. [PMID: 31089691 DOI: 10.1093/ejcts/ezz132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Our goal was to assess the aortic leaflet free margin length (FML) and geometric height (gH) in a normal aortic valve (AV), aorta dilatation and aortic leaflet prolapse. METHODS We measured the FML and gH intraoperatively in 132 patients operated on for aortic insufficiency, aortic dilatation, endocarditis or fibroelastoma. Patients were divided into 3 groups: normal tricuspid AV (group 1, n = 12), aortic dilatation (group 2, tricuspid = 43, bicuspid = 18) and leaflet prolapse (group 3, tricuspid = 32, bicuspid = 27). The FML and gH were compared between the groups and between the leaflets within each group. RESULTS In a normal tricuspid AV, the mean FML and gH were 34.7 ± 3.1 mm and 18.8 ± 1.7 mm, respectively. In group 2 tricuspid, the FML and gH were greater than those in group 1 (FML 43.7 ± 4.4, P < 0.001; gH 21.2 ± 1.8, P = 0.003). In group 3, tricuspid, the FML of the prolapsing leaflet was greater than the FML of the non-prolapsing leaflet (48.3 ± 5.4 vs 42.2 ± 3.6; P < 0.001). In group 2, bicuspid, FML of both leaflets were similar in group 2, but augmented on the fused leaflet compared to the non-fused leaflet in group 3 (fused 55.4 ± 6.3; non-fused 46.2 ± 6.2; P < 0.001). In groups 2 and 3 bicuspid, the gH of the non-fused leaflet was systematically greater than the fused leaflet (group 2 non-fused 24.6 ± 2.5 vs fused 20.4 ± 2.1; P < 0.001). CONCLUSIONS In aortic dilatation and leaflet prolapse, FML and, to a lesser extent, gH increased significantly compared to those of normal AV function. FML and gH dimensions also depended on the valve configuration (tricuspid/bicuspid). These data provide new insight into the pathomorphology of AV disease and will serve to further develop new methods of AV repair based on intraoperative measurements of the FML.
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Affiliation(s)
- Saadallah Tamer
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stefano Mastrobuoni
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Michel van Dyck
- Division of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emiliano Navarra
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Xavier Bollen
- Center for Research in Mechatronics (CEREM), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Alain Poncelet
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Noirhomme
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Parla Astarci
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent de Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Izawa Y, Mori S, Tretter JT, Quintessenza JA, Toh H, Toba T, Watanabe Y, Kono AK, Okada K, Hirata KI. Normative Aortic Valvar Measurements in Adults Using Cardiac Computed Tomography - A Potential Guide to Further Sophisticate Aortic Valve-Sparing Surgery. Circ J 2021; 85:1059-1067. [PMID: 33408304 DOI: 10.1253/circj.cj-20-0938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A thorough understanding of the anatomy of the aortic valve is necessary for aortic valve-sparing surgery. Normal valvar dimensions and their relationships in the living heart, however, have yet to be fully investigated in a 3-dimensional fashion.Methods and Results:In total, 123 consecutive patients (66±12 years, Men 63%) who underwent coronary computed tomographic angiography were enrolled. Mid-diastolic morphology of the aortic roots, including height of the interleaflet triangles, geometric height, free margin length of each leaflet, effective height, and coaptation length were measured using multiplanar reconstruction images. Average height of the interleaflet triangle, geometric height, free margin length, effective height, and the coaptation length were 17.3±1.8, 14.7±1.3, 32.6±3.6, 8.6±1.4, and 3.2±0.8 mm, respectively. The right coronary aortic leaflet displayed the longest free margin length and shortest geometric height. Geometric height, free margin length, and effective height showed positive correlations with aortic root dimensions. Coaptation length, however, remained constant regardless of aortic root dimensions. CONCLUSIONS Diversities, as well as characteristic relationships among each value involving the aortic root, were identified using living-heart datasets. The aortic leaflets demonstrated compensatory elongation along with aortic root dilatation to maintain constant coaptation length. These measurements will serve as the standard value for revealing the underlying mechanism of aortic regurgitation to plan optimal aortic valve-sparing surgery.
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Affiliation(s)
- Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - James A Quintessenza
- The Heart Institute, Cincinnati Children's Hospital Medical Center.,Kentucky Children's Hospital, University of Kentucky, UK Healthcare
| | - Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Morgant MC, Malapert G, Bernard C, Laubriet A, Pujos C, Varin T, Lansac E, Bouchot O. Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results. J Card Surg 2020; 36:1770-1778. [PMID: 33032374 DOI: 10.1111/jocs.15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the role of aortic root remodeling with external aortic annuloplasty (ARREAA) in acute type A aortic dissection (AAAD). METHODS From May 2011 to May 2020, 59 patients out of 240 with AAAD underwent ARREAA. Data were retrospectively collected and analyzed. RESULTS The mean age was 61.4 ± 8.6 years and 43 patients were males (73%). Hemiarch and total arch replacement were performed in 37 (62.7%) and 14 (23.7%) patients. An aortic valvuloplasty was performed in seven patients (11.8%). Five patients (8.5%) required coronary artery bypass graft. Re-exploration for bleeding was required in six patients (10.1%). The 30-day mortality rate was 18.6%. Preoperative hemodynamic instability (odds ratio [OR] = 8.57, 95% confidence interval [CI] = 1.57-46.71; p = 0.013), consciousness disorder (OR = 19.18, 95% CI = 3.02-121.72]; p = 0.002) or myocardial ischemia (OR = 6.28, 95% CI = 1.27-31.10; p = 0.013) were significantly associated with postoperative mortality. No patient was reoperated for aortic valve during the postoperative period. One patient suffered a stroke postoperatively with partial recovery. Kidney failure requiring temporary dialysis occurred in 12 patients (20.3%). At discharge, a transthoracic echocardiogram showed moderate aortic regurgitation (AR; grade 2) in two patients. During follow-up (mean = 58.4 ± 32.4 months), three patients died. The rate of mortality was 6.2%. Actuarial survival at 5 years was 76.3%. No patient required reoperation on the proximal aorta or aortic valve. At 4 years, freedom from any aortic valve or root reintervention and AR > 2 were both 100%. CONCLUSION In a center with expertise in valve-sparing procedures, ARREAA is a reasonable option in the surgical management of AAAD in selected patients. This technique stabilizes the aortic annulus and preserves root anatomy for durable outcomes.
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Affiliation(s)
| | - Ghislain Malapert
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Chloé Bernard
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Aline Laubriet
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Charline Pujos
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Thomas Varin
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Mutualist Montsouris Institute, Paris, France
| | - Olivier Bouchot
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
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12
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Inter-operative determination of the aortic root and cusp geometry associated with the aortic regurgitation grade. Surg Today 2020; 51:384-390. [PMID: 32776293 DOI: 10.1007/s00595-020-02100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSES To perform successful aortic valve plasty (AVP) and valve-sparing root replacement (VSRR), a sufficient understanding of the aortic root and cusp geometry is required. Several key parameters of the aortic root and cusp geometry were, therefore, measured intraoperatively. METHODS Forty-nine patients (63.1 ± 16.6 y.o., 40 males) were measured during the surgeries. The patients were divided into 3 groups; including patients with no or mild aortic valve regurgitation (AR) (n = 13), moderate AR (n = 18), and severe AR (n = 18). RESULTS There were no significant differences in the body surface area (1.72 ± 0.19 m2) among the 3 groups (p = 0.858). The effective height (EH) and geometric height (GH) of right coronary cusp were smaller than those of the others (EH: p = 0.068, GH: p < 0.01). The insertion line length (ILL) and free margin length (FML) of each leaflet tended to be significantly longer according to the AR grade(ILL: p < 0.01, FML: p < 0.01). The FML/AVJ ratios were significantly different (p < 0.01). The FML/ILL ratios were constant with the ratio of 0.88 ± 0.1(p = 0.624). CONCLUSIONS Although the ILL and FML tended to increase with the AR grade, the FML/ILL ratio remained constant. For successful AVP and VSRR, adequately maintaining the FML/ILL ratio is necessary to prevent remarkable cusp prolapse while also preserving its favorable cusp motion.
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13
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Bilkhu R, Tome M, Marciniak A, Edsell M, Jahangiri M. Does the Aortic Annulus Dilate After Aortic Root Remodeling? Ann Thorac Surg 2019; 110:943-947. [PMID: 31846636 DOI: 10.1016/j.athoracsur.2019.10.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The 2 main techniques of valve-sparing aortic root replacement (VSRR) are remodeling and reimplantation. There is concern that the aortic annulus, which is not stabilized in remodeling technique, may dilate over time and cause aortic regurgitation. Our aim was to assess whether the aortic annulus dilates after VSRR with remodeling technique without aortic annuloplasty. METHODS Data on patients undergoing elective or urgent VSRR remodeling technique between 2005 and 2018 were collected. Patients undergoing arch and emergency surgery for acute type A aortic dissection were excluded. Preoperative aortic annulus diameter was measured by transthoracic echocardiography, and this was compared with the annulus diameter measured from the most recently available transthoracic echocardiography. The requirement for reintervention during follow-up was recorded. RESULTS Between 2005 and 2018, 98 patients underwent VSRR. Sixty-six (67.3%) had Marfan syndrome or Loeys-Dietz syndrome. Median age was 60 (interquartile range, 18-68) years and 71 (72.4%) were men. Median cross-clamp and cardiopulmonary bypass times were 122 (interquartile range, 104-164) minutes and 138 (interquartile range, 121-198) minutes, respectively. Median intensive care unit and hospital stay were 1 day and 6 days, respectively. No patients suffered perioperative stroke. There was no in-hospital mortality. At median follow-up of 7.1 years (interquartile range, 5-129 months), mean postoperative annular diameter was 25.7 mm, from 24.2 mm preoperatively (P = .403). One patient required aortic valve replacement during follow-up. Freedom from moderate or severe aortic regurgitation was 97%. CONCLUSIONS There was no significant aortic annular dilatation in selected patients undergoing remodeling VSRR. Our data do not support routine use of annuloplasty in patients with annular diameter less than or equal to 25 mm.
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Affiliation(s)
- Rajdeep Bilkhu
- Department of Cardiothoracic Surgery, St George's Hospital, London, United Kingdom
| | - Maite Tome
- Department of Cardiology, St George's Hospital, London, United Kingdom
| | - Anna Marciniak
- Department of Cardiology, St George's Hospital, London, United Kingdom
| | - Mark Edsell
- Department of Cardiac Anaesthesia, St George's Hospital, London, United Kingdom
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St George's Hospital, London, United Kingdom.
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Hagendorff A, Evangelista A, Fehske W, Schäfers HJ. Improvement in the Assessment of Aortic Valve and Aortic Aneurysm Repair by 3-Dimensional Echocardiography. JACC Cardiovasc Imaging 2019; 12:2225-2244. [DOI: 10.1016/j.jcmg.2018.06.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/31/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022]
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de Heer F, Kluin J, Elkhoury G, Jondeau G, Enriquez-Sarano M, Schäfers HJ, Takkenberg JJ, Lansac E, Dinges C, Steindl J, Ziller R, De Kerchove L, Benkacem T, Coulon C, Elkhoury G, Kaddouri F, Vanoverschelde JL, de Meester C, Pasquet A, Nijs J, Van Mosselvelde V, Loeys B, Meuris B, Schepmans E, Van den Bossche K, Verbrugghe P, Goossens W, Gutermann H, Pettinari M, El-Hamamsy I, Lenoir M, Noly PE, Tousch M, Shah P, Boodhwani M, Rudez I, Baric D, Unic D, Varvodic J, Gjorgijevska S, Vojacek J, Zacek P, Karalko M, Hlubocky J, Novotny R, Slautin A, Soliman S, Arnaud-Crozat E, Boignard A, Fayad G, Bouchot O, Albat B, Leguerrier A, Doguet F, Fuzellier JF, Glock Y, Jondeau G, Fernandez G, Chatel D, Zeitoun DM, Jouan J, Di Centa I, Obadia JF, Leprince P, Houel R, Bergoend E, Lopez S, Berrebi A, Tubach F, Lansac E, Lejeune S, Monin JL, Pousset S, Mankoubi L, Noghin M, Diakov C, Czytrom D, Schäfers HJ, Borger M, Aicher D, Theisohn F, Ferrero P, Stoica S, Matuszewski M, Yiu P, Bashir M, Ceresa F, Patane F, De Paulis R, Chirichilli I, Masat M, Antona C, Contino M, Mangini A, Romagnoni C, Grigioni F, Rosa R, Okita Y, Miyairi T, Kunihara T, de Heer F, Koolbergen D, Marsman M, Gökalp A, Kluin J, Bekkers J, Duininck L, Takkenberg JJ, Klautz R, Van Brakel T, Arabkhani B, Mecozzi G, Accord R, Jasinski M, Aminov V, Svetkin M, Kolesar A, Sabol F, Toporcer T, Bibiloni I, Rábago G, Alvarez-Asiain V, Melero A, Sadaba R, Aramendi J, Crespo A, Porras C, Evangelista Masip A, Kelley S, Bavaria J, Milewski R, Moeller P, Wenger I, Enriquez-Sarano M, Alger S, Alger A, Leavitt K. AVIATOR: An open international registry to evaluate medical and surgical outcomes of aortic valve insufficiency and ascending aorta aneurysm. J Thorac Cardiovasc Surg 2019; 157:2202-2211.e7. [DOI: 10.1016/j.jtcvs.2018.10.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023]
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Petersen J, Voigtländer L, Schofer N, Neumann N, von Kodolitsch Y, Reichenspurner H, Girdauskas E. Geometric changes in the aortic valve annulus during the cardiac cycle: impact on aortic valve repair. Eur J Cardiothorac Surg 2019. [PMID: 29514226 DOI: 10.1093/ejcts/ezy099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The growing experience in aortic valve (AV) repair showed that annular stabilization is a crucial component to achieve stable long-term results after AV repair. Dynamic changes in the AV annulus during the cardiac cycle may have an impact on annuloplasty design. METHODS We retrospectively analysed full cardiac cycle multislice computed tomography data from 58 consecutive patients (mean age 75.9 ± 6.5 years, 36% men) with normally functioning tricuspid AVs (normal AV subgroup). The following computed tomography parameters were measured during systole and diastole: maximum, minimum and mean AV annulus diameter, AV annular area and AV annular perimeter. The AV annular eccentricity index was calculated (%) [(max AV annulus × 100/min AV annulus) - 100] in systole and diastole. Subsequently, multislice computed tomography data from 20 patients with severe aortic regurgitation were analysed [aortic valve regurgitation (AR) subgroup]. RESULTS In the normal AV subgroup, there was a significant decrease in the mean AV annulus diameter from systole to diastole (i.e. 24.6 ± 2.5 mm vs 23.9 ± 2.4 mm, respectively; P < 0.001), which occurred predominantly in the short annular axis (i.e. 21.2 ± 2.4 mm in systole vs 19.9 ± 2.3 mm in diastole; P < 0.001). The mean AV annular area decreased significantly in diastole (i.e. 467.5 ± 94.5 mm2 in systole vs 444.8 ± 86.1 mm2 in diastole; P = 0.012). The annular eccentricity index increased significantly in diastole (33.0 ± 12.2% in systole vs 41.4 ± 13.5% in diastole; P < 0.001). Furthermore, we found an inverse linear correlation between the mean AV annulus diameter and the annular eccentricity index (r = -0.40, P = 0.034). The diastolic annular eccentricity index was significantly reduced in the AR subgroup (i.e. 41.4 ± 13.5% in the normal AV subgroup vs 33.7 ± 14.8% in the AR cohort; P = 0.035). CONCLUSIONS The normal AV annulus undergoes important geometric deformation during the cardiac cycle that is significantly reduced in diastole in the AR scenario. A novel AV annuloplasty system should ideally adapt for this marked diastolic annular eccentricity and thereby allow for dynamic aortic root changes during the cardiac cycle.
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Affiliation(s)
- Johannes Petersen
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Lisa Voigtländer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Niklas Neumann
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | | | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Commentary: When does aortic valve repair become a root replacement? J Thorac Cardiovasc Surg 2019; 158:e29. [PMID: 31005297 DOI: 10.1016/j.jtcvs.2019.02.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/23/2022]
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Chirichilli I, Irace F, Weltert L, Tsuda K, Scaffa R, Salica A, Galea N, De Paulis R. Morphological modification of the aortic annulus in tricuspid and bicuspid valves after aortic valve reimplantation: an electrocardiography-gated computed tomography study†. Eur J Cardiothorac Surg 2019; 56:778-784. [DOI: 10.1093/ejcts/ezz065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES:
Aortic valve-sparing operations have been shown to produce fewer valve-related complications than valve replacement. The aortic root is a morphological and functional unit in which the annulus plays an important role on dynamism, shape and geometry of the valve with different results in bicuspid aortic valves (BAVs) or tricuspid aortic valves (TAVs). The aim is to evaluate the differences in the size and shape of the aortic annulus between native BAVs and TAVs using ECG-gated computed tomography (CT) after a reimplantation procedure.
METHODS:
We selected 35 patients scheduled for aortic valve reimplantation who underwent good-quality preoperative and postoperative ECG-gated contrast-enhanced CT scan of the aortic root. Twenty-three patients had TAV, 8 patients type 1 BAV and 4 patients type 0 BAV. Major diameter and minor diameter, perimeter (P) and area (A) were measured. The shape of the aortic annulus was considered ‘circular’ or ‘elliptic’ according to the Ellipticity Index. We also selected a subgroup of 18 patients (9 TAVs and 9 BAVs) to evaluate annular shape and size variations through the cardiac cycle and to study the expansibility both in the preoperative and in the postoperative phases.
RESULTS:
Preoperative CT scans showed an elliptic shape of TAVs (Ellipticity Index 1.3 ± 0.1), a circular shape of type 0 BAVs (1.1 ± 0.1) and an intermediate behaviour of type 1 BAVs, suggesting a possible gradual spectrum of circularity from TAVs to type 1 BAVs to type 0 BAVs. Postoperative CT scans did not show any significant difference in annular shape among the 3 groups, which demonstated a similar roundness, obviating the preoperative differences. Analysing the expansibility of the aortic annulus during the cardiac cycle, we observed that it was completely absent in the preoperative phase in BAVs, while in the postoperative phase, both TAVs and BAVs showed a small but similar expansibility after the annular reduction.
CONCLUSIONS:
There is a possible gradual spectrum in terms of shape, from native TAVs, to type 1 BAVS to type 0 BAVs. These differences are eliminated in the postoperative phase, suggesting an active role of the annuloplasty on the geometry of the aortic annulus. The preoperative analysis showed a complete inelasticity of BAVs, which was partly restored in the postoperative phase.
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Affiliation(s)
| | - Francesco Irace
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Kazumasa Tsuda
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Raffaele Scaffa
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Andrea Salica
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
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Aortic root remodeling in bicuspid and tricuspid aortic valves-long-term results. Indian J Thorac Cardiovasc Surg 2019; 36:81-87. [PMID: 33061188 DOI: 10.1007/s12055-019-00798-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022] Open
Abstract
Background Root remodeling is one form of valve-preserving root replacement to treat patients with aortic regurgitation (AR) and root aneurysm. We have consistently used it for patients with and without connective tissue disease and different aortic valve morphologies. The objective of this retrospective study was to review 23 years of experience with root remodeling. Methods and patients Between 10/95 and 9/2018, 1004 of 1038 root remodeling procedures were performed in patients with tricuspid (n = 589) or bicuspid (n = 414) anatomy of the aortic valve in our institution. Aortic aneurysm was present in 932 cases, 73 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade I to grade IV (mean 2.5 ± 0.8). Results All patients underwent root remodeling, concomitant operations were performed in 433, and cusp repair in 883 instances. Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 89% at 15 years. It was 94% for tricuspid valves at 10 and 15 years, and 88% for bicuspid aortic valves at 10 years and 80% at 15 years (p = 0.003). Conclusion In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.
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Hagendorff A, Stoebe S, Tayal B. A systematic approach to 3D echocardiographic assessment of the aortic root. Glob Cardiol Sci Pract 2018; 2018:12. [PMID: 30083542 PMCID: PMC6062762 DOI: 10.21542/gcsp.2018.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/18/2018] [Indexed: 12/25/2022] Open
Abstract
[first paragraph of article]Severe aortic regurgitation (AR) and/or severe abnormalities of the aortic root and the tubular ascending aorta (TAA) are indications for surgical treatment. The correct diagnosis, the choice of optimal treatment, as well as optimal timing of surgery, mainly depend on findings obtained by echocardiography - which is usually the initial diagnostic modality applied in clinical practice. Therefore, an appropriate morphological and functional quantification of the aortic valve (AV) and the aortic root complex is required. Aside from the need of standardization to provide a precise objective evaluation, the use of modern echocardiographic technologies - especially 3D-echocardiography -are less often implemented in clinical routine. The present manuscript focuses on the advantages of transthoracic and transesophageal 3D-echocardiography (TTE, TEE) for an improved assessment of the AV and the aortic root complex to provide accurate and comprehensive measurements for making the correct diagnosis and defining further therapeutic strategies.
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Affiliation(s)
| | - Stephan Stoebe
- Dep. of Cardiology, University Hospital Leipzig, Germany
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Ridley C, Sohmer B, Vallabhajosyula P, Augoustides JG. Aortic Leaflet Billowing as a Risk Factor for Repair Failure After Aortic Valve Repair. J Cardiothorac Vasc Anesth 2017; 31:1001-1006. [DOI: 10.1053/j.jvca.2017.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 11/11/2022]
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Schäfers HJ. Aortic annuloplasty: The panacea of valve-preserving aortic replacement? J Thorac Cardiovasc Surg 2017; 153:1043-1044. [DOI: 10.1016/j.jtcvs.2017.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
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Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg 2017; 153:1033-1042. [DOI: 10.1016/j.jtcvs.2016.12.031] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/25/2016] [Accepted: 12/09/2016] [Indexed: 12/20/2022]
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Furukawa K, Kamohara K, Yunoki J, Koga S, Itoh M, Morokuma H, Mukae Y, Itoh T, Morita S. Should the annulus be fixed in aortic valve-sparing root replacement with remodeling? Gen Thorac Cardiovasc Surg 2017; 65:200-205. [PMID: 28229270 DOI: 10.1007/s11748-017-0751-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES If the aortic root dilates after native aortic valve-sparing root reconstruction with remodeling, aortic regurgitation may recur. However, it has not been demonstrated clearly that the aortic root dilates after remodeling. METHODS This study enrolled 15 patients who underwent an aortic valve-sparing operation with remodeling (2002-2014) but without any ventriculo-aortic junction (VAJ) fixation. Technically, special care was taken to pass the sutures through the fibrous annulus. The diameter of the aortic root (VAJ, neosinus of Valsalva, and sinotubular junction), degree of aortic regurgitation, and effective height of the aortic valve were measured in the patients. All patients had postoperative follow-up, and the median follow-up period was 7.3 (IQR: 3.1-8.3) years. RESULTS The mean preoperative diameters of the VAJ, sinus of Valsalva, and sinotubular junction were 23.5 ± 2.3 (20-27) mm, 51.1 ± 7.2 (43-60) mm, and 42.4 ± 9.4 (29-58) mm, respectively. The postoperative diameters of the VAJ changed from 21.6 ± 2.6 (early) to 21.8 ± 2.9 mm (late) (p = 0.75). The diameters of the sinus of Valsalva and sinotubular junction changed from 26.5 ± 3.0 (early) to 28.5 ± 4.2 mm (late) (p = 0.0013), and 22.4 ± 3.0 (early) to 24.3 ± 3.3 mm (late) (p = 0.0003), respectively. The effective height of the aortic valve changed from 9.7 ± 1.3 (early) to 8.9 ± 2.0 mm (late) (p = 0.08). The degree of aortic regurgitation (grade: 0-4) changed from 0.3 ± 0.5 (early) to 1.2 ± 0.8 (late) (p = 01558). CONCLUSIONS Significant VAJ dilation and changes in aortic valve configuration after our remodeling procedure were not observed. Therefore, fixation of the annulus with remodeling may not be needed for cases without preoperative dilation of the annulus.
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Affiliation(s)
- Kojiro Furukawa
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Keiji Kamohara
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shugo Koga
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Manabu Itoh
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroyuki Morokuma
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yosuke Mukae
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tsuyoshi Itoh
- Department of Cardiovascular Surgery, Fukuoka Wajiro Hospital, 2-2-75 Higashiku Wajirogaoka, Fukuoka, Japan
| | - Shigeki Morita
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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da Costa FDA, Colatusso DDFF, da Costa ACBA, Balbi Filho EM, Cavicchioli VN, Lopes SAV, Ferreira ADDA, Collatusso C. Initial Surgical Experience with Aortic Valve Repair: Clinical and Echocardiographic Results. Braz J Cardiovasc Surg 2016; 31:183-90. [PMID: 27556321 PMCID: PMC5062723 DOI: 10.5935/1678-9741.20160027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/08/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Due to late complications associated with the use of conventional prosthetic
heart valves, several centers have advocated aortic valve repair and/or
valve sparing aortic root replacement for patients with aortic valve
insufficiency, in order to enhance late survival and minimize adverse
postoperative events. Methods From March/2012 thru March 2015, 37 patients consecutively underwent
conservative operations of the aortic valve and/or aortic root. Mean age was
48±16 years and 81% were males. The aortic valve was bicuspid in
54% and tricuspid in the remaining. All were operated with the aid of
intraoperative transesophageal echocardiography. Surgical techniques
consisted of replacing the aortic root with a Dacron graft whenever it was
dilated or aneurysmatic, using either the remodeling or the reimplantation
technique, besides correcting leaflet prolapse when present. Patients were
sequentially evaluated with clinical and echocardiographic studies and mean
follow-up time was 16±5 months. Results Thirty-day mortality was 2.7%. In addition there were two late deaths, with
late survival being 85% (CI 95% - 68%-95%) at two years. Two patients were
reoperated due to primary structural valve failure. Freedom from reoperation
or from primary structural valve failure was 90% (CI 95% - 66%-97%) and 91%
(CI 95% - 69%-97%) at 2 years, respectively. During clinical follow-up up to
3 years, there were no cases of thromboembolism, hemorrhage or
endocarditis. Conclusions Although this represents an initial series, these data demonstrates that
aortic valve repair and/or valve sparing aortic root surgery can be
performed with satisfactory immediate and short-term results.
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Holubec T, Higashigaito K, Belobradek Z, Dergel M, Harrer J, Alkadhi H, Zacek P, Vojacek J. An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study. Ann Thorac Surg 2016; 103:83-90. [PMID: 27457826 DOI: 10.1016/j.athoracsur.2016.05.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 04/21/2016] [Accepted: 05/23/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to assess effectiveness, stability, position, and expansibility of an expansible aortic annuloplasty ring with computed tomography (CT). METHODS Ten men (median age 51 years) scheduled for aortic root remodeling with implantation of external annuloplasty ring underwent contrast-enhanced CT of the aortic root preoperatively, postoperatively, and at a median of 21 months after operation. A reconstructed transverse double oblique view of the aortic base (AB) and of the new defined annuloplasty ring base (ARB; plane of the lower edge of the ring) in systole and diastole were obtained. The diameters, perimeter, and area were measured. In addition, the distances between AB and ARB in the nadir of each sinus were measured. RESULTS We found 12% reduction of the postoperative AB and 19% of ARB perimeter in both systole (p = 0.004, p < 0.001, respectively) and diastole (p = 0.001, p < 0.001, respectively) compared with preoperative. There was 22% reduction of the postoperative AB area in systole and 24% in diastole (p = 0.002, p = 0.001, respectively) and 33% reduction of the ARB area in systole and 32% in diastole (p < 0.001 for both) compared with the preoperative period. Nearly all measured variables in the follow-up period showed a slight increase compared with the postoperative period; however, they did not reach statistical significance. The postoperative systolic-diastolic differences in the three measured variables at the level of AB and ARB were statistically significant and were maintained throughout the follow-up period. The base of the ring was implanted 2 ± 2 mm at the right, 0 ± 1 mm at the left above the AB, and 2 (-3 to 2) mm at the noncoronary nadir below the AB. CONCLUSIONS This study demonstrates imaging evidence of the effectiveness, stability, and pulsatility of the annuloplasty ring in aortic root remodeling in follow-up and describes the exact position of the ring at the base of the aortic root.
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Affiliation(s)
- Tomas Holubec
- Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Zdenek Belobradek
- Department of Radiology, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martin Dergel
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Harrer
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pavel Zacek
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Lansac E, Di Centa I, Sleilaty G, Lejeune S, Khelil N, Berrebi A, Diakov C, Mankoubi L, Malergue MC, Noghin M, Zannis K, Salvi S, Dervanian P, Debauchez M. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg 2016; 50:350-60. [DOI: 10.1093/ejcts/ezw070] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/25/2016] [Indexed: 01/18/2023] Open
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Kunihara T. Annular management during aortic valve repair: a systematic review. Gen Thorac Cardiovasc Surg 2015; 64:63-71. [DOI: 10.1007/s11748-015-0602-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Indexed: 10/22/2022]
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Overview of current surgical strategies for aortic disease in patients with Marfan syndrome. Surg Today 2015; 46:1006-18. [DOI: 10.1007/s00595-015-1278-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
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Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2015; 100:1126-31. [DOI: 10.1016/j.athoracsur.2015.05.093] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/20/2015] [Accepted: 05/14/2015] [Indexed: 11/17/2022]
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De Paulis R, Chirichilli I, Scaffa R, Weltert L, Maselli D, Salica A, Guerrieri Wolf L, Bellisario A, Chiariello L. Long-term results of the valve reimplantation technique using a graft with sinuses. J Thorac Cardiovasc Surg 2015; 151:112-9. [PMID: 26349596 DOI: 10.1016/j.jtcvs.2015.08.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/27/2015] [Accepted: 08/08/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Aortic valve reimplantation is the most commonly used technique to spare the aortic valve. Long-term results data are scarce and available only with the use of standard straight graft. We examined the long-term results of reimplantation of the aortic valve using a graft incorporating sinuses of Valsalva. METHODS From May 2000 to December 2014, 124 patients had an aortic valve reimplanted into a graft with sinuses of Valsalva. The mean age was 53 ± 13 years and the majority were men (87%). Marfan syndrome was present in 21 patients (17%) and 12% had a bicuspid valve. Patients were prospectively followed by means of transthoracic echocardiography. The mean follow-up was 63 ± 52 months. RESULTS Overall survival at 5, 10, and 13 years was 94.4% ± 2.2%, 90.5% ± 4.4%, and 81.4% ± 7.3%, respectively. Six patients required reoperation within a time frame of 6 to 96 months. None of the patients died at reoperation. Freedom from reoperation was 95.4% ± 2.3% at 5 years and 90.1% ± 4.3% at 10 and 13 years. All patients who needed reoperation had surgery during the first 5 years. Three patients had residual aortic insufficiency >2. Considering also all patients who underwent reoperation because of aortic insufficiency, freedom from moderate to severe residual aortic insufficiency was 94.1% ± 2.6% at 5 years, and 87.1% ± 4.7% at 10 and 13 years. CONCLUSIONS The majority of patients who had their valve reimplanted in a graft with sinuses continue to perform well after 10 years.
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Affiliation(s)
| | | | | | - Luca Weltert
- Cardiac Surgery Department, European Hospital, Rome, Italy
| | | | - Andrea Salica
- Cardiac Surgery Department, European Hospital, Rome, Italy
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Mazzitelli D, Fischlein T, Rankin JS, Choi YH, Stamm C, Pfeiffer S, Pirk J, Detter C, Kroll J, Beyersdorf F, Griffin CD, Shrestha M, Nöbauer C, Crooke PS, Schreiber C, Lange R. Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg 2015; 49:987-93. [DOI: 10.1093/ejcts/ezv234] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/03/2015] [Indexed: 01/09/2023] Open
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Barannyk O, Oshkai P. The Influence of the Aortic Root Geometry on Flow Characteristics of a Prosthetic Heart Valve. J Biomech Eng 2015; 137:051005. [DOI: 10.1115/1.4029747] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Indexed: 11/08/2022]
Abstract
In this paper, performance of aortic heart valve prosthesis in different geometries of the aortic root is investigated experimentally. The objective of this investigation is to establish a set of parameters, which are associated with abnormal flow patterns due to the flow through a prosthetic heart valve implanted in the patients that had certain types of valve diseases prior to the valve replacement. Specific valve diseases were classified into two clinical categories and were correlated with the corresponding changes in aortic root geometry while keeping the aortic base diameter fixed. These categories correspond to aortic valve stenosis and aortic valve insufficiency. The control case that corresponds to the aortic root of a patient without valve disease was used as a reference. Experiments were performed at test conditions corresponding to 70 beats/min, 5.5 L/min target cardiac output, and a mean aortic pressure of 100 mmHg. By varying the aortic root geometry, while keeping the diameter of the orifice constant, it was possible to investigate corresponding changes in the levels of Reynolds shear stress and establish the possibility of platelet activation and, as a result of that, the formation of blood clots.
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Affiliation(s)
- Oleksandr Barannyk
- Mem. ASME Department of Mechanical Engineering, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Peter Oshkai
- Mem. ASME Department of Mechanical Engineering, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada
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Izzat MB, Hamzeh K, Mahmoud F, Bakour MM. Aortic cusp sizers to establish the functional classification of aortic insufficiency: algorithm and midterm outcome of operative repair. Interact Cardiovasc Thorac Surg 2015; 21:77-80. [PMID: 25842078 DOI: 10.1093/icvts/ivv081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/13/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Wider adoption of aortic valve repair procedures is held up by the difficulty in recognizing the exact alterations that are responsible for aortic valve insufficiency. New aortic cusp sizers were developed to assist in aortic valve assessment in the operating theatre. Our objectives were to examine the efficacy of the aortic cusp sizers in establishing the functional classification of aortic valve insufficiency, and to report the midterm outcome in a group of patients who had undergone aortic valve repair guided by this device. METHODS A prospective clinical study was performed involving 33 consecutive patients (18 males, age range: 8-74 years) with severe aortic valve insufficiency (mean severity: 3.4 ± 0.5). The aortic cusp sizers were used as a template to identify existing cusp and root alterations. Consequently, the functional classification of aortic insufficiency was determined, and the appropriate techniques of aortic valve repair were implemented. RESULTS Aortic valve repair was successful in all patients. Procedures performed were 37 functional aortic annulus corrections, 9 cusp free-edge plications, 2 cusp repairs with autologous pericardium, 9 replacements of the ascending aorta and 2 reimplantation procedures. At a mean follow-up time of 18.3 ± 13.7 months, 1 patient underwent aortic valve replacement for recurrent aortic valve regurgitation, while aortic valve function remained stable in 32 patients, with aortic insufficiency <1+ in 27 (84.4%) patients and 1-1.5 in 5 (15.6%) patients, and no significant gradients across the aortic valves. CONCLUSIONS The aortic cusp sizers are valuable in establishing the functional classification of aortic insufficiency, and can guide implementation of aortic valve repair techniques successfully. This approach is analogous to that accredited for the success and wide adoption of mitral valve repair techniques, and is likely to assist in increasing the percentage of aortic valves that are repaired when compared with current practice.
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Affiliation(s)
| | - Khaled Hamzeh
- Damascus University Cardiac Surgery Hospital, Damascus, Syria
| | - Fadi Mahmoud
- Damascus University Cardiac Surgery Hospital, Damascus, Syria
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Khelil N, Sleilaty G, Palladino M, Fouda M, Escande R, Debauchez M, Di Centa I, Lansac E. Surgical Anatomy of the Aortic Annulus: Landmarks for External Annuloplasty in Aortic Valve Repair. Ann Thorac Surg 2015; 99:1220-6. [DOI: 10.1016/j.athoracsur.2014.12.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/02/2014] [Accepted: 12/05/2014] [Indexed: 10/23/2022]
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de Kerchove L, Mastrobuoni S, Boodhwani M, Astarci P, Rubay J, Poncelet A, Vanoverschelde JL, Noirhomme P, El Khoury G. The role of annular dimension and annuloplasty in tricuspid aortic valve repair. Eur J Cardiothorac Surg 2015; 49:428-37; discussion 437-8. [DOI: 10.1093/ejcts/ezv050] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/12/2015] [Indexed: 01/05/2023] Open
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Abstract
The key for successful valve repair is full understanding of the regurgitant mechanism and sufficient evaluation of the valve. Currently, multidetector computed tomography has been introduced for evaluation. The aortic valve can be analyzed in details preoperatively. The main causes of aortic regurgitation (AR) in the adult population are degenerative leaflet change and annulus dilatation. Restoration to normal structure can be accomplished mainly by plication. Central leaflet plication near the Arantius nodule is a simple technique for redundant tissue. For leaflet deficiency, pericardial patch plasty may be an option. No universal technique exists for plication of the aortic annulus. The valve-sparing aortic root replacement firmly stabilizes the ventriculo-aortic junction (VAJ) and assures repair durability even in patients with mild to moderate root dilatation. Subcommissural annuloplasty (Cabrol stitch) does not seem sufficient for the prevention of VAJ dilatation. Circumferential annuloplasties may have a greater potential. However, convenient device for annular plication is still in development. The bicuspid aortic valve is a congenital heart valve lesion. A basic technique is free margin plication of the fused leaflet. Aortic root dilatation may contribute to AR severity. Valve-sparing aortic root replacement may improve repair durability. Considering the great advances in valve repair, young patients with AR should be informed that valve repair is a promising option for surgical treatment.
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de Kerchove L, Jashari R, Boodhwani M, Duy KT, Lengelé B, Gianello P, Nezhad ZM, Astarci P, Noirhomme P, El Khoury G. Surgical anatomy of the aortic root: Implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg 2015; 149:425-33. [DOI: 10.1016/j.jtcvs.2014.09.042] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/05/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
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Schäfers HJ. Aortic valve repair: Easy and reproducible? J Thorac Cardiovasc Surg 2015; 149:129-30. [DOI: 10.1016/j.jtcvs.2014.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE Root remodeling was proposed as valve-preserving root replacement to treat patients with aortic regurgitation and root aneurysm. The objective of this retrospective study was to review 18 years of experience with root remodeling and to identify predictors of valve durability. METHODS Between October 1995 and December 2013, root remodeling was performed in 747 patients. The aortic valve anatomy was tricuspid in 431 patients, bicuspid in 290 patients, and unicuspid in 26 patients. Aortic aneurysm was present in 688 patients, and 59 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade 0 to IV (grade 0, 1%; grade 1, 8%; grade 2, 26%; grade 3, 62%; grade 4, 3%; median, 3). All patients underwent root remodeling, concomitant operations were performed in 352 patients, and cusp repair was used in 690 procedures. RESULTS Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 91% at 15 years. Overall freedom from reoperation was 95% for tricuspid valves at 10 and 15 years, 89% for bicuspid aortic valves at 10 years (P = .006), and 83% for bicuspid aortic valves at 15 years. By multivariate analysis, the strongest risk factors for failure were an aortoventricular junction 28 mm or greater (hazard ratio, 1.43) and the use of a pericardial patch as part of cusp repair (hazard ratio, 6.24). CONCLUSIONS Root remodeling continues to be a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve geometry, reproducible restoration of aortic valve function can be achieved with good long term durability.
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Standardized approach to valve repair using an expansible aortic ring versus mechanical Bentall: early outcomes of the CAVIAAR multicentric prospective cohort study. J Thorac Cardiovasc Surg 2014; 149:S37-45. [PMID: 25240525 DOI: 10.1016/j.jtcvs.2014.07.105] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/22/2014] [Accepted: 07/25/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The study objective was to compare the 30-day outcomes of a standardized aortic valve repair technique (REPAIR group) associating root remodeling with an expansible aortic ring annuloplasty versus mechanical composite valve and graft (CVG group) replacement in treating aortic root aneurysms. METHODS A total of 261 consecutive patients with aortic root aneurysm were enrolled in this multicentric prospective cohort (131 in the CVG group, 130 in the REPAIR group) in 20 centers. The main end point is a composite criterion including mortality; reoperation; thromboembolic, hemorrhagic, or infectious events; and heart failure. Secondary end points were major adverse valve-related events. Crude and propensity score adjusted estimates are provided. RESULTS The mean age was 56.1 years, and the valve was bicuspid in 115 patients (44.7%). The median (interquartile range) preoperative aortic insufficiency grade was 2.0 (1.0-3.0) in the REPAIR group and 3.0 (2.0-3.0) in the CVG group (P = .0002). Thirty-day mortality was 3.8% (n = 5) in both groups (P = 1.00). Despite a learning curve and longer crossclamp times for valve repair (147.7 vs 99.8 minutes, P < .0001), the 2 groups did not differ significantly for the main criterion (odds ratio, 1.31; 95% confidence interval, 0.72-2.40; P = .38) or 30-day mortality (odds ratio, 0.99; 95% confidence interval, 0.28-3053; P = .99), with a trend toward more frequent major adverse valve-related events in the CVG group (odds ratio, 2.52; 95% confidence interval, 0.86-7.40; P = .09). At discharge, 121 patients (96.8%) in the REPAIR group had grade 0 or 1 aortic insufficiency. CONCLUSIONS A new standardized approach to valve repair, combining an expansible aortic annuloplasty ring with the remodeling technique, presented similar 30-day results to mechanical CVG with a trend toward reducing major adverse valve-related events. Analysis of late outcomes is in process for 3- and 10-year follow-ups.
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Rey E, Hamzeh G, Crespo A, Cubero A, Cortés A, Aramendi JI. Cirugía reparadora de la insuficiencia aórtica. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mazzitelli D, Stamm C, Rankin JS, Nöbauer C, Pirk J, Meuris B, Crooke PS, Wagner A, Beavan LA, Griffin CD, Powers D, Nasseri B, Schreiber C, Hetzer R, Lange R. Hemodynamic outcomes of geometric ring annuloplasty for aortic valve repair: A 4-center pilot trial. J Thorac Cardiovasc Surg 2014; 148:168-75. [DOI: 10.1016/j.jtcvs.2013.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 08/05/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
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Técnicas de reparación valvular aórtica. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koolbergen DR, Manshanden JSJ, Bouma BJ, Blom NA, Mulder BJM, de Mol BAJM, Hazekamp MG. Valve-sparing aortic root replacement†. Eur J Cardiothorac Surg 2014; 47:348-54; discussion 354. [DOI: 10.1093/ejcts/ezu167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yamaguchi H, Nakao T, Kadowaki T, Nakamura H, Tokunaga N, Yoda M, Takagaki M. Successful bicuspid aortic valve repair using external aortic annuloplasty. Ann Thorac Surg 2014; 97:1443-5. [PMID: 24694428 DOI: 10.1016/j.athoracsur.2013.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 05/18/2013] [Accepted: 07/01/2013] [Indexed: 10/25/2022]
Abstract
A 33-year-old man presented with severe aortic insufficiency due to a prolapsed bicuspid aortic valve. The ventriculoaortic junction was dilated to 29 mm without root dilatation, and external ring annuloplasty was performed using a Gelweave (Terumo, Tokyo, Japan) graft to reduce the size to 22 mm. The leaflets were repaired by dividing and suturing a raphe between the right and left cusps. This combination provided adequate coaptation depth (8 mm) and showed excellent results, with trivial aortic insufficiency. This approach is suitable for repair of a bicuspid aortic valve with a dilated ventriculoaortic junction without root dilatation.
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Affiliation(s)
- Hiroki Yamaguchi
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan.
| | - Tatsuya Nakao
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Tasuku Kadowaki
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Hiromasa Nakamura
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Noriyuki Tokunaga
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Masataka Yoda
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Masami Takagaki
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
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Technische Durchführung der Aortenklappenrekonstruktion. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-013-1070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Richardt D, Bucsky B, Charitos EI, Sievers HH, Scharfschwerdt M. A Novel Rigid Annuloplasty Ring for Aortic Valve Reconstruction: An In Vitro Investigation. Ann Thorac Surg 2014; 97:811-5. [DOI: 10.1016/j.athoracsur.2013.09.097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/02/2013] [Accepted: 09/09/2013] [Indexed: 11/17/2022]
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Fok M, Shaw M, Sancho E, Abello D, Bashir M. Aortic Valve Repair: A Systematic Review and Meta-analysis of Published Literature. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:10-21. [PMID: 26798710 DOI: 10.12945/j.aorta.2014.14-003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/21/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED Background : It is widely accepted that aortic valve disease is surgically managed with aortic valve replacement (AVR) using different available prostheses. The long-term survival, durability of the valve, and freedom from reoperation after AVR are well established in published literature. Over the past two decades, aortic valve repair (AVr) has evolved into an accepted surgical option for patients with aortic valve disease. We review and analyze the published literature on AVr. Methods : A systematic review of the current literature was performed through three electronic databases from inception to August 2013 to identify all relevant studies relating to aortic valve repair. Articles selected were chosen by two reviewers. Articles were excluded if they contained a pediatric population or if the patient number was less than 50. RESULTS Twenty-four studies conformed to the inclusion criteria for inclusion in the systematic review. In total, 4986 patients underwent aortic valve repair. 7 studies represented bicuspid aortic valve (BAV) repair, 5 studies represented cusp prolapse, and 3 studies represented valve repair with root dilation or aneurysm. Overall weighted in-hospital mortality for all studies was low (1.46% ± 1.21). Preoperative aortic insufficiency (AI) ≥ 2+ did not correlate to reoperation for valve failure (Pearson's Rs 0.2705, P = 0.2585). AI at discharge was reported in 9 studies with a mean AI ≥ 2+ in 6.1% of patients. Weighted average percentage for valve reoperation following BAV repair was 10.23% ± 3.2. Weighted average reoperation following cusp prolapse repair was 3.83 ± 1.96. Weighted average reoperation in aortic valve sparing procedures with root replacement was 4.25% ± 2.46. Although there are limitations and complications of prosthetic valves, especially for younger individuals, there is ample published literature that confers strong evidence for AVR. On the contrary, aortic valve repair may be a useful option for selected patients, but there is lack of uniformity in data and absence of compelling supporting evidence. An international multi-center study comparing and assessing the results between AVR & AVr is the next step required. Currently, higher levels of evidence do not exist for aortic valve repair.
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Affiliation(s)
- Matthew Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; and
| | - Matthew Shaw
- Clinical Research Unit, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Elena Sancho
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; and
| | - David Abello
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; and
| | - Mohamad Bashir
- Thoracic Aortic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; and
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50
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Aortic valve repair in patients with aortic regurgitation: Experience with the first 100 cases. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2013.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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