1
|
Matta A, Bayard N, Revel-Mouroz P, Marcheix B, Bouisset F. Percutaneous Approach for Late Left Main Coronary Detachment Resulting in Aortic Pseudoaneurysm After Bentall Procedure. JACC Case Rep 2021; 3:1586-1588. [PMID: 34729506 PMCID: PMC8543132 DOI: 10.1016/j.jaccas.2021.05.016] [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] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022]
Abstract
We describe the case of 35-year-old patient with known Marfan syndrome, and previously treated by a Bentall procedure, who presented with an aortic pseudoaneurysm secondary to a partial proximal left main coronary artery detachment fixed by covered stent implantation. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Anthony Matta
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Nathanael Bayard
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
| | - Paul Revel-Mouroz
- Department of Radiology, Rangueil University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Address for correspondence: Dr Frédéric Bouisset, Department of Cardiology, Toulouse University Hospital, 1, avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France.
| |
Collapse
|
2
|
Javadikasgari H, Roselli EE, Aftab M, Suri RM, Desai MY, Khosravi M, Cikach F, Isabella M, Idrees JJ, Raza S, Tappuni B, Griffin BP, Svensson LG, Gillinov AM. Combined aortic root replacement and mitral valve surgery: The quest to preserve both valves. J Thorac Cardiovasc Surg 2017; 153:1023-1030.e1. [DOI: 10.1016/j.jtcvs.2017.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 12/28/2016] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
|
3
|
Mookhoek A, Korteland NM, Arabkhani B, Di Centa I, Lansac E, Bekkers JA, Bogers AJ, Takkenberg JJ. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2016; 101:1684-9. [DOI: 10.1016/j.athoracsur.2015.10.090] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
|
4
|
Kataoka G, Nakano K, Asano R, Sato A, Kodera K, Tatsuishi W, Sudo S. Midterm results of left coronary artery reimplantation through the transverse sinus of the pericardium in adult Bland-White-Garland syndrome. Surg Case Rep 2016; 1:24. [PMID: 26943392 PMCID: PMC4747939 DOI: 10.1186/s40792-015-0027-3] [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: 11/25/2014] [Accepted: 02/18/2015] [Indexed: 11/12/2022] Open
Abstract
The anomalous origin of the left coronary artery from the pulmonary artery - known as Bland-White-Garland syndrome - is a rare congenital malformation that affects 1 in 300,000 live births. Most patients die in infancy without any surgical treatment. Some patients who survive past childhood often have varying symptoms such as myocardial ischemia, impaired left ventricular function, mitral regurgitation, and progressive heart failure, depending on the development collateral circulation. In the present report, we describe a procedure wherein the left coronary artery ostium was translocated through the transverse sinus of the pericardium in a 43-year-old mother with Bland-White-Garland syndrome and concomitant mitral regurgitation and report on the associated midterm results.
Collapse
Affiliation(s)
- Go Kataoka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan.
| | - Kiyoharu Nakano
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan.
| | - Ryota Asano
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan.
| | - Atsuhiko Sato
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan.
| | - Kojiro Kodera
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan.
| | - Wataru Tatsuishi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, 116-8567, Tokyo, Japan.
| | - Shinji Sudo
- Department of Cardiovascular Medicine, Yatsu Hoken Hospital, Chiba, Japan.
| |
Collapse
|
5
|
Svensson LG, Pillai ST, Rajeswaran J, Desai MY, Griffin B, Grimm R, Hammer DF, Thamilarasan M, Roselli EE, Pettersson GB, Gillinov AM, Navia JL, Smedira NG, Sabik JF, Lytle BW, Blackstone EH. Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement. J Thorac Cardiovasc Surg 2015; 151:764-774.e4. [PMID: 26778214 DOI: 10.1016/j.jtcvs.2015.10.113] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate long-term results of aortic root procedures combined with ascending aorta replacement for aneurysms, using 4 surgical strategies. METHODS From January 1995 to January 2011, 957 patients underwent 1 of 4 aortic root procedures: valve preservation (remodeling or modified reimplantation, n = 261); composite biologic graft (n = 297); composite mechanical graft (n = 156); or allograft root (n = 243). RESULTS Seven deaths occurred (0.73%), none after valve-preserving procedures, and 13 strokes (1.4%). Composite grafts exhibited higher gradients than allografts or valve preservation, but the latter 2 exhibited more aortic regurgitation (2.7% biologic and 0% mechanical composite grafts vs 24% valve-preserving and 19% allografts at 10 years). Within 2 to 5 years, valve preservation exhibited the least left ventricular hypertrophy, allograft replacement the greatest; however, valve preservation had the highest early risk of reoperation, allograft replacement the lowest. Patients receiving allografts had the highest risk of late reoperation (P < .05), and those receiving composite mechanical grafts and valve preservation had the lowest. Composite bioprosthesis patients had the highest risk of late death (57% at 15 years vs 14%-26% for the remaining procedures, P < .0001), because they were substantially older and had more comorbidities (P < .0001). CONCLUSIONS These 4 aortic root procedures, combined with ascending aorta replacement, provide excellent survival and good durability. Valve-preserving and allograft procedures have the lowest gradients and best ventricular remodeling, but they have more late regurgitation, and likely, less risk of valve-related complications, such as bleeding, hemorrhage, and endocarditis. Despite the early risk of reoperation, we recommend valve-preserving procedures for young patients when possible. Composite bioprostheses are preferable for the elderly.
Collapse
Affiliation(s)
- Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Saila T Pillai
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard Grimm
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Donald F Hammer
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Maran Thamilarasan
- Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jose L Navia
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas G Smedira
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph F Sabik
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce W Lytle
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
6
|
Toeg H, Chan V, Rao RV, Chan KL, Ruel M, Mesana T, Boodhwani M. Contemporary midterm echocardiographic outcomes of Bentall procedure and aortic valve sparing root replacement. Ann Thorac Surg 2014; 98:590-6. [PMID: 24968770 DOI: 10.1016/j.athoracsur.2014.04.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Valve sparing root replacement (VSRR) and aortic valve repair (AVr) is an attractive treatment option compared with composite valve and root replacement (Bentall procedure) for patients with aortic root dilatation with or without aortic valve disease. While aortic valve preservation reduces the risk of valve-related complications, little is known about echocardiographic differences at follow-up between these 2 strategies. METHODS Consecutive nonemergent patients undergoing VSRR and AVr (n=68) were compared with contemporary historical controls undergoing the Bentall procedure for aortic root pathology with or without mixed aortic valve disease (insufficiency or stenosis) (n=96). The VSRR was performed preferentially using the reimplantation technique. Bentall procedure utilized a mechanical valve in 65% of patients, a biologic prosthesis in 22%, and a homograft in 13%. Clinical and echocardiographic data were obtained at baseline and at follow-up (median=30 months). RESULTS The 2 cohorts were similar with respect to all preoperative characteristics with the exception of disease etiology. The Bentall group had a higher proportion of degenerative valve and root disease (47.8% vs 27.9%) and a lower proportion of bicuspid aortic valve disease (22.8% vs 51.5%) as compared with the VSRR group (p=0.007). Postoperative echocardiographic outcomes were comparable between groups with the exception of higher peak (23.37±11.80 vs 18.0±12.04; p=0.02) and mean (13.07±7.53 vs 9.56±6.49; p=0.01) transvalvular aortic gradients in the Bentall group. Persistence of left ventricular dysfunction (8.4% vs 6.1%; p=0.61), presence of greater than moderate aortic valve (AV) insufficiency (3% vs 4.6%; p=0.32), and left ventricular mass (213.24±72.36 vs 207.38±63.07, p=0.61) were comparable between the Bentall and VSRR group, respectively. Finally, survival (p=0.21) and freedom from valve-related events (p=0.74) were similar between groups. CONCLUSIONS Valve sparing root replacement with AV repair provides similar mid-term echocardiographic and clinical outcomes compared with the Bentall.
Collapse
Affiliation(s)
- Hadi Toeg
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rajeev V Rao
- Division of Cardiology (Echocardiography), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kwan-Leung Chan
- Division of Cardiology (Echocardiography), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
7
|
Kato Y, Hattori K, Motoki M, Takahashi Y, Nishimura S, Shibata T. Left coronary ostial stenosis after the modified bentall using a long interposed coronary graft in a patient with pectus excavatum. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:758-60. [PMID: 23445802 DOI: 10.5761/atcs.cr.12.02155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 26-year-old man presented chest oppression. He had pectus excavatum associated with Loeys-Dietz syndrome and a history of redo aortic root replacement with the modified Bentall technique using an 8-mm long interposed graft to the left coronary ostium. Coronary angiography revealed severe stenosis of both left coronary ostium and proximal left anterior descending artery, which was supposed to be resulted from thrombosis in the interposed graft. The left coronary system was bypassed through a left thoracotomy, which was suitable in this patient because the pectus excavatum would prevent harvest of the left internal thoracic artery through re-median sternotomy and to avoid potential sternal reentry injury of the heart. Although the left anterior descending artery was easily accessed under off-pump technique, exposure and anastomosis of the circumflex coronary artery was more difficult than expected without cardiopulmonary bypass as the pectus excavatum and adhesion of the heart prevented anterior shift and rotation of the heart.
Collapse
Affiliation(s)
- Yasuyuki Kato
- Department of Cardiovascular Surgery, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan
| | | | | | | | | | | |
Collapse
|
8
|
Senanayake EL, Cooper GJ. Indirect re-implantation of the left coronary artery during aortic surgery. J Card Surg 2012; 27:205-10. [PMID: 22458276 DOI: 10.1111/j.1540-8191.2012.01421.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Indirect re-implantation of the left coronary artery (LCA) via an interposition graft simplifies difficult LCA re-implantation during aortic root replacement. Little information exists regarding the results of this technique. In this study, we report our experience. METHODS Between January 2001 and July 2008, of 82 aortic root replacements, 24 (mean age 48.2 years, 83% male) used the indirect re-implantation technique. All case notes were retrospectively analyzed. Indications for operation were; aortic root aneurysm (n = 16), acute dissection (n = 6), existent homograft calcification (n = 1), failed Ross procedure (n = 1). Reasons for indirect re-implantation were: difficult LCA mobilization secondary to previous cardiac surgery (n = 7), short left main stem (n = 6), acute dissection (n = 6), adherence to surrounding tissues (n = 5). All patients had yearly CT or MRI follow-up. RESULTS Mechanical and tissue valved conduits were implanted in 22 and two patients, respectively. Ten millimeters (n = 17) or 8 mm (n = 7) Dacron grafts were used for LCA re-implantation. Thirty-day mortality was 12.5%. Postoperative complications were: re-opening for bleeding (n = 2), pericardial effusion (n = 4), renal failure (n = 1). Over a median follow-up of 26 months (range 4 to 81), one developed a false aneurysm at the right coronary artery anastomosis five months postoperatively, which was subsequently repaired. All interposition grafts remained patent on MRI or CT. There were six late deaths. At median follow-up survival rate was 71%. CONCLUSIONS The indirect re-implantation of the LCA during aortic root replacements is a reliable, safe, and effective method in dealing with the LCA in difficult circumstances. Survival at 26 months is equivalent to other series of similar patients.
Collapse
Affiliation(s)
- Eshan L Senanayake
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom
| | | |
Collapse
|
9
|
Stamou SC, Murphy MC, Kouchoukos NT. Left ventricular outflow tract reconstruction and translocation of the aortic valve for annular erosion: early and midterm outcomes. J Thorac Cardiovasc Surg 2010; 142:292-7. [PMID: 21130469 DOI: 10.1016/j.jtcvs.2010.09.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 08/24/2010] [Accepted: 09/17/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement without endocarditis, and its surgical management is challenging. We present the early and midterm results of a technique for left ventricular outflow tract and aortic root reconstruction with a polyester tube graft and translocation of the aortic valve and coronary arteries. METHODS A polyester tube graft is placed into the left ventricle and sutured to the left ventricular outflow tract below the area of erosion. The graft is then everted and sutured to a composite graft. Interposition polyester grafts from the coronary arteries are attached to the composite graft above the valve. This technique has been used in 12 cases. All but 1 patient had previously undergone aortic root or aortic valve replacement, and 4 had endocarditis of prosthetic (n = 2) or aortic allograft (n = 2) valves. RESULTS There were no in-hospital deaths. There was 1 early death from pulmonary embolism at 1 postoperative month and 2 late deaths at 15 and 64 postoperative months, both resulting from heart failure. The remaining 9 patients are alive at 3 to 132 postoperative months. Actuarial 5-year survival is 75%. CONCLUSIONS Left ventricular outflow tract reconstruction with translocation of the aortic valve and coronary arteries for annular erosion is a useful technique that safely excludes the area of annular erosion and eliminates left ventricular outflow tract obstruction. The procedure can be safely performed with satisfactory early outcomes and 5-year survival.
Collapse
Affiliation(s)
- Sotiris C Stamou
- Division of Thoracic and Cardiovascular Surgery, Missouri Baptist Medical Center, St Louis, MO, USA
| | | | | |
Collapse
|
10
|
Park KJ, Woo JS, Cho GJ, Bang JH, Jeong SS. Clinical Study of Composite Valve Graft Replacement of the Aortic Root. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.3.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kwon-Jae Park
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital
| | - Jong Soo Woo
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital
| | - Gwang Jo Cho
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital
| | - Jung Hee Bang
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital
| | - Sang Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital
| |
Collapse
|
11
|
Girardi LN. Invited Commentary. Ann Thorac Surg 2009; 87:115-6. [DOI: 10.1016/j.athoracsur.2008.10.086] [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: 10/27/2008] [Revised: 10/27/2008] [Accepted: 10/28/2008] [Indexed: 10/21/2022]
|