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Gallegos RP, Gersak B. The Sutureless Biological Bentall Procedure: A New Technique to Create a Modular Valve-Conduit Construct. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:320-325. [PMID: 37458235 DOI: 10.1177/15569845231185797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The Perceval sutureless valve (Corcym, Saluggia, Italy) has been effectively adopted by surgeons for the treatment of degenerative aortic valve stenosis. Its simplified true sutureless implantation technique has proven useful for minimally invasive cases, but the use of Perceval as part of more complex root replacement has not previously been described. We present a novel technical modification to the manufactured biologic Bentall, called the sutureless biological Bentall. This technique allows for a true modular valve-conduit construction that will simplify future reintervention.
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Affiliation(s)
| | - Borut Gersak
- University of Ljubljana School of Medicine, Slovenia
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2
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6564539. [DOI: 10.1093/ejcts/ezac193] [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: 09/30/2021] [Revised: 02/16/2022] [Accepted: 03/15/2022] [Indexed: 11/12/2022] Open
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3
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Witten JC, Durbak E, Houghtaling PL, Unai S, Roselli EE, Bakaeen FG, Johnston DR, Svensson LG, Jaber W, Blackstone EH, Pettersson GB. Performance and Durability of Cryopreserved Allograft Aortic Valve Replacements. Ann Thorac Surg 2021; 111:1893-1900. [DOI: 10.1016/j.athoracsur.2020.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
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Abstract
Degenerative aortic stenosis is the most common valvular disease worldwide; however, its physiopathology remains poorly understood. Although, developments in prevention of this disease have remained relatively stagnant, the last decade has brought about innovative treatment options incorporating different percutaneous and surgical approaches. These advances have allowed physicians to offer relief to high-risk patients, previously deemed nonsurgical. Increasingly, there is a shift toward offering percutaneous valve replacement to moderate and low-risk patients with aortic stenosis. Enthusiasm for a new treatment option must always be tempered by caution; as defining appropriate patient selection is essential to achieve optimal outcomes.
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Affiliation(s)
- Alice Le Huu
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, & The Texas Heart Institute, Houston, TX, USA
| | - Dominique Shum-Tim
- Division of Cardiac Surgery & Surgical Research, Department of Surgery, McGill University, Montreal, QC, Canada
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Serraino GF, Zanobini M, Beghi C, Maselli D, Bashir M, Mastroroberto P, Mariscalco G. Perspective. Reoperative Bentall: choice of conduits. Indian J Thorac Cardiovasc Surg 2019; 35:127-129. [PMID: 33061077 DOI: 10.1007/s12055-017-0607-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 11/24/2022] Open
Abstract
The Bentall procedure represents the gold standard in the treatment of patients requiring aortic root replacement. The most common indications for redo Bentall are structural degeneration or graft infection. Redo aortic root replacement can be performed with low perioperative morbidity and death. The choice of the best conduit is still up for debate but is mandatory to guarantee the best and most durable option for the patient. New options are available to reduce mortality in older or fragile patients and can modify the conduit choice.
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Affiliation(s)
- Giuseppe Filiberto Serraino
- Department of experimental and clinical medicine, University Magna Graecia of Catanzaro, Germaneto, Catanzaro Italy
| | - Marco Zanobini
- Cardiac Surgery Department, IRCCS Cardiologico Monzino, Milan, Italy
| | - Cesare Beghi
- Cardiac Surgical Department, Insubria University of Varese, Varese, Italy
| | - Daniele Maselli
- Cardiac Surgical Department, S.Anna Hospital, Catanzaro, Italy
| | - Mohamad Bashir
- Cardiothoracic Surgery, Barts Health NHS Trust, London, UK
| | - Pasquale Mastroroberto
- Department of experimental and clinical medicine, University Magna Graecia of Catanzaro, Germaneto, Catanzaro Italy
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital Groby Road, Leicester, UK
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Crestanello JA. Aortic homografts: Unrealized expectations and hard reoperations at the end. J Thorac Cardiovasc Surg 2018; 156:1351-1352. [PMID: 29884491 DOI: 10.1016/j.jtcvs.2018.04.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 11/16/2022]
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Fiedler AG, Tolis G. Surgical Treatment of Valvular Heart Disease: Overview of Mechanical and Tissue Prostheses, Advantages, Disadvantages, and Implications for Clinical Use. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:7. [DOI: 10.1007/s11936-018-0601-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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8
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Shekar PS, Rinewalt D. Those who do not remember the past are condemned to repeat it. Ann Cardiothorac Surg 2017; 6:538-540. [PMID: 29062751 DOI: 10.21037/acs.2017.09.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) for aortic valve stenosis has rapidly progressed from its initial application in the inoperable or high-risk patients to those determined to be intermediate and low risk. It is our concern this has occurred without adequate knowledge or examination of the long-term durability of TAVR valves and the impact on subsequent aortic valve surgery, should it be required. In this editorial, we provide insight and reflect upon lessons learned from past surgical techniques and their subsequent abandonment.
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Affiliation(s)
- Prem S Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Rinewalt
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
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9
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Jassar AS, Desai ND, Kobrin D, Pochettino A, Vallabhajosyula P, Milewski RK, McCarthy F, Maniaci J, Szeto WY, Bavaria JE. Outcomes of aortic root replacement after previous aortic root replacement: the "true" redo root. Ann Thorac Surg 2015; 99:1601-8; discussion 1608-9. [PMID: 25754965 DOI: 10.1016/j.athoracsur.2014.12.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aortic reoperations are technically challenging. This study evaluated outcomes after "true" redo root replacement (previous full root replacement) stratified by cause of prosthesis failure. METHODS Data were compared for 793 patients who underwent a first-time sternotomy (de novo group) and 120 patients who had previously undergone full aortic root replacement (redo group), of which 76 underwent reoperation due to structural valve deterioration (degenerative group), and 44 due to endocarditis (infection group). RESULTS Overall mortality was 4% (n = 28) in the de novo group and 5% (n = 6) in the redo group (p = 0.43) (degenerative group, 3%, infection group, 9%; p = 0.19). The infection group had an increased incidence of renal failure, sternal infection, prolonged ventilation, reoperation for bleeding, multisystem failure, and sepsis, and an increased hospital length of stay. The degenerative group and the de novo group had a similar risk of perioperative death and major complications. The 5-year survival was 86.3% ± 1.3% for the de novo group and 77.3% ± 4.6% for the redo group (p ≤ 0.01; degenerative, 86.3% ± 5%; infection, 65.3% ± 7.7%; p < 0.01; p = 0.98 for de novo vs degenerative). Multivariate analysis demonstrated that reoperation for degenerative failure did not increase the risk of perioperative or late death. CONCLUSIONS Redo aortic root replacement can be performed with low perioperative morbidity and death. The presence of infection increases the risk of complications and worsens survival. However, redo root replacement for degenerative failure can be performed with similar short-term complication risk and midterm survival as de novo root replacement.
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Affiliation(s)
- Arminder S Jassar
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dale Kobrin
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alberto Pochettino
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Rita K Milewski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fenton McCarthy
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon Maniaci
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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Meszaros K, Liniger S, Czerny M, Stanger O, Reineke D, Englberger L, Carrel TP. Mid-term results of aortic root replacement using a self-assembled biological composite graft. Interact Cardiovasc Thorac Surg 2014; 19:584-9. [DOI: 10.1093/icvts/ivu186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Folliguet TA, Laborde F. Sutureless Perceval aortic valve replacement in aortic homograft. Ann Thorac Surg 2013; 96:1866-8. [PMID: 24182479 DOI: 10.1016/j.athoracsur.2013.02.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/31/2013] [Accepted: 02/06/2013] [Indexed: 10/26/2022]
Abstract
We report a case of aortic valve replacement with a sutureless valve in a degenerated aortic homograft. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It avoids the problems of postoperative prosthetic disinsertion frequently encountered after aortic valve replacement in a calcified annulus. It is particularly suitable in redo procedures for homograft degeneration. It avoids performing a redo Bentall operation with its known morbidity.
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Affiliation(s)
- Thierry A Folliguet
- Institut Lorrain du Coeur & des Vaisseaux Louis Mathieu, Centre Hospitalier Universitaire, Vandoeuvre les Nancy, France.
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Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria JE, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reardon M, Reece TB, Reiss GR, Roselli EE, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic Valve and Ascending Aorta Guidelines for Management and Quality Measures. Ann Thorac Surg 2013; 95:S1-66. [DOI: 10.1016/j.athoracsur.2013.01.083] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 12/24/2012] [Accepted: 01/15/2013] [Indexed: 12/31/2022]
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Andrew Borger M, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Anton Sirnes P, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Tornos Mas P, Trindade PT, Walther T. Guíade práctica clínica sobre el tratamiento de las valvulopatías (versión 2012). Rev Esp Cardiol (Engl Ed) 2013. [DOI: 10.1016/j.recesp.2012.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012). Eur J Cardiothorac Surg 2012; 42:S1-44. [DOI: 10.1093/ejcts/ezs455] [Citation(s) in RCA: 1024] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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15
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Finch J, Roussin I, Pepper J. Failing stentless aortic valves: redo aortic root replacement or valve in a valve? Eur J Cardiothorac Surg 2012; 43:495-504. [PMID: 22933569 DOI: 10.1093/ejcts/ezs335] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Reoperation for failing stentless aortic valve replacement is a technically demanding procedure that has traditionally been tackled in one of two ways: either root replacement or the more conservative option of implanting a stented valve within the valve. We sought to determine the relative operative risks, follow-up status and medium to long-term survival of these two methods. METHODS We conducted a retrospective review of a single surgeon's experience of the two techniques over a 10-year period from 2000 to 2010. Excluding cases of active endocarditis, 110 patients were identified, of which 65 underwent 'valve-in-valve' procedures ('Group A') and 45 had redo root replacement ('Group B'). The most common bioprostheses reoperated were homografts (roots or subcoronary implants) and Toronto Stentless Porcine Valves. Aortic valve replacement alone was performed in 68% in Group A and 64% in Group B, with males comprising 75% of Group A and 82% of Group B. Average ages were 61.5 ± 14.2 years and 61.9 ± 12.1 years, respectively. RESULTS Operative and cardiopulmonary bypass durations were significantly greater for redo root procedures and correspondingly, postoperative complications were more common. Thirty-day mortality after valve-in-valve replacement was 3%, and after redo root replacement it was 11%. Despite significantly higher transvalvular gradients in Group B, the symptomatic status was equally good at 2 months, 1 year and last follow-up. At an average interval of 5.1 ± 2.7 years for Group A, survival was 83% vs 76% at 7.3 ± 2.9 years for Group B. There have been two reinterventions in Group A and 3 in Group B. Only one valve-in-valve patient has developed a paraprosthetic leak. CONCLUSIONS This retrospective review has confirmed our hypothesis that where both root diameter permits and satisfactory debridement can be performed, valve-in-valve replacement is the more conservative surgical strategy for stentless aortic valve replacement revision. Although transvalvular gradients on echocardiography are significantly higher with the introduction of a stented prosthesis, medium-term outcomes in terms of symptomatic status, late complications and reintervention rate were non-inferior. We await the medium-term results of transcatheter aortic valve implantation for the same indication with interest.
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Affiliation(s)
- Jonathan Finch
- Department of Adult Cardiac Surgery, Royal Brompton Hospital, London, UK
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33:2451-96. [PMID: 22922415 DOI: 10.1093/eurheartj/ehs109] [Citation(s) in RCA: 2612] [Impact Index Per Article: 217.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
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- Service de Cardiologie, Hospital Bichat AP-HP, 46 rue Henri Huchard, 75018 Paris, France.
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Kowert A, Vogt F, Beiras-Fernandez A, Reichart B, Kilian E. Outcome after homograft redo operation in aortic position. Eur J Cardiothorac Surg 2012; 41:404-8. [DOI: 10.1016/j.ejcts.2011.04.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 11/16/2022] Open
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Ravenni G, Pratali S, Scioti G, Bortolotti U. Total calcification of an aortic homograft used as aortic root replacement. J Cardiovasc Med (Hagerstown) 2011; 12:191-2. [PMID: 20104179 DOI: 10.2459/jcm.0b013e3283356639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 66-year-old man presented with total calcification of a homograft used as aortic root replacement approximately 10 years previously. Reoperation consisted of complete dissection of the homograft and en-bloc replacement with a mechanical conduit. Despite careful dissection the right coronary ostium was disrupted requiring reconstruction by interposition of a saphenous vein segment. Reoperation for failure of homografts used as aortic root replacement represents a major technical challenge.
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Affiliation(s)
- Giacomo Ravenni
- Cardiothoracic and Vascular Department, Section of Cardiac Surgery, University of Pisa, Medical School, Pisa, Italy
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19
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Malvindi PG, van Putte BP, Leone A, Heijmen RH, Schepens MAAM, Morshuis WJ. Aortic reoperation after freestanding homograft and pulmonary autograft root replacement. Ann Thorac Surg 2011; 91:1135-40. [PMID: 21353201 DOI: 10.1016/j.athoracsur.2011.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/03/2011] [Accepted: 01/04/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human allografts and pulmonary autografts offer many advantages as an aortic valve and root substitute. The progressive degeneration of the aortic allograft and the pulmonary autograft has been seen as an important disadvantage, and the need for a reoperation has been perceived as challenging and risky for the patients. METHODS Between March 1992 and October 2009, 53 consecutive patients (mean age 50 ± 13 years; 38 male), who had a previous aortic root replacement, underwent redo surgery for failure of the aortic homograft (n = 42) or the pulmonary autograft (n = 11). The median follow-up (available for 47 of 51 patients) was 44 months. RESULTS Structural valve deterioration was the main indication for reoperation on the homograft (86%), with an earlier presentation in patients who received homografts from donors more than 55 years old. Failure of the pulmonary autograft occurred primarily because of severe aortic regurgitation predominantly due to dilation of the autograft (n = 5) and autograft valve prolapse (n = 5). The total in-hospital mortality was 3.8% (n = 2). No deaths occurred among patients who previously underwent a Ross procedure. The course was complicated in 25 cases (48%). The cumulative 1-year, 5-year, and 8-year survival rates were 92%, 90%, and 77%, respectively. No late deaths were encountered after reoperation on the pulmonary autograft (maximum follow-up 218 months). Freedom from reoperation (excluding early in-hospital operation) for recurrent aortic valve or root pathology was 97% at 8 years. CONCLUSIONS Reoperation after freestanding homograft and pulmonary autograft root replacement can be accomplished safely. The total postoperative morbidity rate is still high.
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Affiliation(s)
- Pietro G Malvindi
- Department of Cardiac Surgery, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
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20
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Bekkers JA, Klieverik LMA, Raap GB, Takkenberg JJM, Bogers AJJC. Re-operations for aortic allograft root failure: experience from a 21-year single-center prospective follow-up study. Eur J Cardiothorac Surg 2011; 40:35-42. [PMID: 21227717 DOI: 10.1016/j.ejcts.2010.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/03/2010] [Accepted: 11/08/2010] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The study aims to report results of re-operations after aortic allograft root implantation. METHODS All consecutive patients in our prospective allograft database, who underwent aortic allograft root implantation, were selected for analysis, and additional information for patients who subsequently underwent re-operation was obtained from hospital records. RESULTS From 1989 to 2009, 262 aortic allograft root implantations were performed. Thirty-day mortality was 5.7%. During follow-up, 69 patients died. The actuarial survival was 77.0% (95% confidence interval (CI) 71-83%) after 10 years, and 65.1% (95% CI 57-74%) after 14 years. A total of 52 patients required re-operation. The actuarial freedom from allograft re-operation was 82.9% (Standard Error (SE) 2.9%) after 10 years and 55.7% (SE 5.7%) after 14 years. The actuarial median time to re-operation was 14.8 years. The indications for re-operation were structural valve dysfunction in 46 patients, endocarditis in two patients and non-structural valve dysfunction in four patients. The re-operations included 23 aortic valve replacements (mechanical prostheses 20 and bioprostheses 3), 27 aortic root replacements (mechanical conduits 21, aortic allografts five, and biological conduit one), one trans-apical valve implantation and one primary closure of a false aneurysm. The additional procedures were mitral valve repair (N = 5), mitral valve replacement (N = 1), ascending aortic replacement (N = 5), and coronary artery bypass grafting (CABG) (N = 4; in two patients unforeseen). Thirty-day mortality after re-operation occurred in two patients (3.9%). Five patients died during follow-up. The survival after re-operation was 87.1% (SE 5.5%) after 1 year and 79.3% (SE 7.4%) after 9 years. CONCLUSIONS Re-operations after aortic allograft root implantation will be required in a substantial and growing number of patients. These re-operations, although technically demanding, can be performed with satisfying results.
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Affiliation(s)
- Jos A Bekkers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
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21
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Rouhani AS, Pratali S, Scioti G, Bortolotti U. Annular enlargement for failed aortic root homograft. J Cardiovasc Med (Hagerstown) 2010; 13:413-4. [PMID: 21135581 DOI: 10.2459/jcm.0b013e32834064bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Pereda D, Park SJ. "Freezing" the left ventricular outflow tract for homograft reconstruction in aortic root endocarditis. J Thorac Cardiovasc Surg 2010; 141:301-3. [PMID: 20599227 DOI: 10.1016/j.jtcvs.2010.05.005] [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: 04/29/2010] [Accepted: 05/05/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel Pereda
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA
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23
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Modified bio-Bentall procedure: 10-year experience. Eur J Cardiothorac Surg 2010; 37:1317-21. [DOI: 10.1016/j.ejcts.2009.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 12/03/2009] [Accepted: 12/07/2009] [Indexed: 11/20/2022] Open
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24
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Schmoeckel M, Boekstegers P, Nikolaou K, Reichart B. First successful transapical aortic valve implantation after aortic allograft replacement. J Thorac Cardiovasc Surg 2009; 138:1016-7. [DOI: 10.1016/j.jtcvs.2009.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/17/2009] [Indexed: 10/20/2022]
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