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Lysenko AV, Salagaev GI, Lednev PV, Belov YV. [Long-term result of aortic root remodeling using the Florida sleeve technique in a patient with connective tissue dysplasia and aortic root aneurysm without aortic insufficiency]. Khirurgiia (Mosk) 2024:141-145. [PMID: 38634595 DOI: 10.17116/hirurgia2024041141] [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: 04/19/2024]
Abstract
Aortic root remodeling using the Florida sleeve technique was proposed as a simpler alternative to classical reconstructive interventions in patients with aortic root aneurysm without aortic insufficiency. We present a 10-year result of valve-sparing surgical treatment using the Florida sleeve technique in a patient with connective tissue dysplasia and aortic root aneurysm.
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Affiliation(s)
- A V Lysenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G I Salagaev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - P V Lednev
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - Yu V Belov
- Petrovsky National Research Center of Surgery, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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2
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6538731. [DOI: 10.1093/ejcts/ezac104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
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3
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Alhussaini M, Jeng EI, Martin TD, Fillion A, Beaver TM, Arnaoutakis GJ. Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection. J Card Surg 2021; 37:39-46. [PMID: 34652039 DOI: 10.1111/jocs.16078] [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: 09/06/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute type-A aortic dissection (ATAAD). The Florida sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the FS repair in patients with dilated roots in the setting of an ATAAD. METHODS We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. RESULTS Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range, 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. CONCLUSION FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.
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Affiliation(s)
| | - Eric I Jeng
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Tomas D Martin
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Amber Fillion
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Thomas M Beaver
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - George J Arnaoutakis
- Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
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Tasca G, Jaworek M, Lucherini F, Trinca F, Redaelli P, Antona C, Vismara R. Leaflet kinematics after the Yacoub and Florida-sleeve operations: results of an in vitro study. Eur J Cardiothorac Surg 2021; 59:674-679. [PMID: 33236049 DOI: 10.1093/ejcts/ezaa370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/14/2020] [Accepted: 09/05/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The Florida-sleeve is a valve-sparing technique that causes minimal interference to leaflet kinematics and aortic root dynamism. The aim of this in vitro study was to evaluate the effects of the Florida-sleeve and Yacoub techniques on aortic leaflet kinematics. METHODS Two groups of 6 whole porcine hearts were treated with either the Florida-sleeve technique or the Yacoub technique and tested in a pulsatile loop. Valve fluid dynamics, coronary flow analysis and valve echocardiograms were performed both before and after the procedures. RESULTS Both procedures showed no difference in rapid valve opening time as compared with their respective baseline values. The Florida-sleeve procedure showed a shorter slow closing time (192 ± 19 ms vs baseline 244 ± 14 ms, P = 0.016) and increased slow closing velocity (-1.5 ± 0.4 cm/s vs baseline -0.8 ± 0.4 cm/s, P = 0.038). In the rapid valve closing phase, the Yacoub procedure showed a trend towards slower closing valve velocity (-16 ± 9 cm/s vs baseline -25 ± 9 cm/s, P = 0.07). The Yacoub procedure showed larger leaflet displacement at the end of the slow valve closing time that was 2.0 ± 0.5 cm vs baseline 1.5 ± 0.3 cm, P = 0.044. When comparing the Florida-sleeve and Yacoub procedures, the former showed statistically significant shorter slow valve closing time (P = 0.017). CONCLUSIONS This study showed that the Florida-sleeve technique alters the slow closing phase of the aortic valve leaflet kinematics when compared with both the normal baseline and Yacoub procedure, while the latter showed a larger leaflet displacement before the rapid closing valve phase.
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Affiliation(s)
- Giordano Tasca
- Department of Cardiac Surgery, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.,Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Michal Jaworek
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federico Lucherini
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesco Trinca
- Cardiovascular Department, Operative Unit of Cardiac Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Paola Redaelli
- Cardiovascular Department, Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Carlo Antona
- Cardiovascular Surgery Department, ASST Fatebenefratelli "Luigi Sacco" University Hospital, Milan, Italy
| | - Riccardo Vismara
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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5
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Uglov KA, Sorokina AA, Konoval'chuk EV, Voronova OV, Sidorov RV, Uglov AI. [Operation in DeBakey type I acute aortic dissection according to the Florida Sleeve technique]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:118-124. [PMID: 35050256 DOI: 10.33529/angio2021407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite the fact that recent decades have witnessed significant advances in treatment of patients with DeBakey type I acute aortic dissection, it still remains difficult to restore the aortic root when the dissection extends to the Valsalva's sinuses. Thinned aortic walls are vulnerable to traumatization on applying a vascular suture. We used in patients with this pathology the Florida sleeve technique in order to reinforce the weakened aortic root. After mobilization of the aortic root and coronary arteries, the transplant 'wraps' the sinuses from the outside, like the neoadventitia, in order to strengthen the weakened aortic wall. The graft's diameter should be selected with due regard for tight enwrapment of coronary sinuses in their maximal dilatation and, if necessary, preserving the possibility of narrowing the fibrous ring. This technique is simple and effective. First, it allows strengthening the weakened root, secondly helping to prevent haemorrhage. Besides, it may prove alternative, should preservation or correction of the geometry of the aortic root be required.
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Affiliation(s)
- K A Uglov
- Department of Cardiac Surgery, Centre for Cardiovascular Surgery, Clinical Hospital "Russian Railways - Medicine", Rostov-on-Don, Russia; Chair of Surgical Diseases #2, Rostov State Medical University of the RF Ministry of Public Health, Rostov-on-Don, Russia; Department of Cardiac Surgery, Centre of Cardiology and Cardiovascular Surgery, Clinic of the Rostov State Medical University, Rostov-on-Don, Russia
| | - A A Sorokina
- Department of Cardiac Surgery, Centre for Cardiovascular Surgery, Clinical Hospital "Russian Railways - Medicine", Rostov-on-Don, Russia
| | - E V Konoval'chuk
- Department of Cardiac Surgery, Centre for Cardiovascular Surgery, Clinical Hospital "Russian Railways - Medicine", Rostov-on-Don, Russia
| | - O V Voronova
- Department of Cardiac Surgery, Centre for Cardiovascular Surgery, Clinical Hospital "Russian Railways - Medicine", Rostov-on-Don, Russia
| | - R V Sidorov
- Chair of Surgical Diseases #2, Rostov State Medical University of the RF Ministry of Public Health, Rostov-on-Don, Russia; Department of Cardiac Surgery, Centre of Cardiology and Cardiovascular Surgery, Clinic of the Rostov State Medical University, Rostov-on-Don, Russia
| | - A I Uglov
- Department of Cardiac Surgery, Centre for Cardiovascular Surgery, Clinical Hospital "Russian Railways - Medicine", Rostov-on-Don, Russia
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6
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Khvan DS, Sirota DA, Zhul'kov MO, Liashenko MM, Cherniavskiĭ AM. Remote results of Florida Sleeve technique in patients with ascending aortic aneurysms and aortic insufficiency. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:108-118. [PMID: 33332313 DOI: 10.33529/angio2020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The aim of our investigation was to assess the remote results of valve-sparing aortic root reimplantation into the graft (Florida Sleeve technique) compared with reimplantation of the aortic valve into the graft (David technique) during surgical correction of ascending aortic aneurysms accompanied by concomitant aortic insufficiency. PATIENTS AND METHODS Our single-centre, blind, prospective, randomized study carried out from 2011 to 2015 included a total of 64 patients with ascending aortic aneurysms and aortic insufficiency. The patients were randomized into 2 groups: group I - aortic root reimplantation according to the Florida Sleeve technique (FS group) and group II - reimplantation of the aortic valve according to the T. David technique in David I modification (D group). The groups did not statistically differ by the baseline clinical profile. RESULTS The overall 7-year survival for the FS group and D group amounted to 83% and 85.6%, respectively (p=0.98). Assessing the competing risks of mortality related to cardiovascular or other causes revealed no differences. Freedom from prosthetic repair of the aortic valve in the remote follow-up period amounted to 92.8% and 85.8% for the FS group and D group, respectively (p=0.4). According to the obtained findings, the technique of a valve-sparing operation is not a predictor of either lethality (RR 0.98 (95% CI 0.23-4.15), p=0.98) or prosthetic repair of the aortic valve (RR 2.03 (95% CI 0.40-14.63), p=0.40) in the remote period of follow up. RCONCLUSION Aortic root reimplantation inside the prosthesis according to the Florida Sleeve technique makes it possible to simplify and accelerate the procedure of aortic root reconstruction in patients with aortic root aneurysms and concomitant aortic insufficiency, demonstrating long-term results comparable with those of the David technique.
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Affiliation(s)
- D S Khvan
- Centre for Surgery of the Aorta, Coronary and Peripheral Arteries, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - D A Sirota
- Centre for Surgery of the Aorta, Coronary and Peripheral Arteries, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - M O Zhul'kov
- Centre for Surgery of the Aorta, Coronary and Peripheral Arteries, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - M M Liashenko
- Centre for Surgery of the Aorta, Coronary and Peripheral Arteries, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A M Cherniavskiĭ
- Centre for Surgery of the Aorta, Coronary and Peripheral Arteries, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
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Aalaei-Andabili SH, Beaver TM, Martin TD, Hess PJ, Arnaoutakis GJ. Outcomes of Florida Sleeve Procedure in Patients with Bicuspid Versus Tricuspid Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:361-368. [PMID: 32729751 DOI: 10.1177/1556984520938470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outcomes of the Florida Sleeve (FS) procedure in patients with bicuspid aortic valve (BAV) have not been reported before. We compared outcomes of the FS procedure between patients with BAV and those with tricuspid aortic valve (TAV). METHODS From May 1, 2002 to January 1, 2016, 177 patients including 18 BAV and 159 TAV underwent the FS procedure. Baseline characteristics, perioperative outcomes, and echocardiographic measurements were compared between the 2 groups. Kaplan-Meier and life-table analyses were used to evaluate survival and freedom from reintervention rates. RESULTS Mean ± standard deviation age and aortic root diameter were comparable in BAV and TAV groups, 47.83 ± 11.19 versus 49.59 ± 15.79 years (P = 0.55) and 56.57 ± 6.18 versus 55.17 ± 8.84 mm (P = 0.46), respectively. The 30-day mortality and stroke rates were zero in the BAV group and 1.88% (n = 3) in the TAV group (P = 1.00). One patient (5.55%) in the BAV group and 8 (5.03%) patients in the TAV group needed permanent pacemaker implantation (P = 0.62). Freedom from reoperation was 93% in the BAV group and 99% in the TAV group at 8 years (P = 0.041). Patient survival rate was 100% in the BAV group and 91% in the TAV group at 8 years (P = 0.42). Freedom from aortic insufficiency greater than mild was 93% in the BAV group and 96.5% in the TAV group at 5 years (P = 0.61). CONCLUSIONS This is the first study reporting outcomes of the FS procedure in patients with BAV. This technique is feasible, and the results appear to be durable when compared to patients with TAV.
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Affiliation(s)
- Seyed Hossein Aalaei-Andabili
- 3463 Department of Medicine, University of Florida, Gainesville, FL, USA.,Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Tomas D Martin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Philip J Hess
- 22535 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Indiana University, Bloomington, IN, USA
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
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8
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Tasca G, Trinca F, Riva B, Lobiati E, Nasatti A, Faccioli P, Gamba A. Sleeve valve-sparing procedure in bicuspid aortic valve: early and midterm clinical results. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:250-255. [DOI: 10.23736/s0021-9509.20.11051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Aalaei-Andabili SH, Martin TD, Hess PJ, Karimi A, Bavry AA, Arnaoutakis GJ, Beaver TM. The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:49-55. [PMID: 31529428 PMCID: PMC6748854 DOI: 10.1055/s-0039-1687854] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background
The Florida (FL) Sleeve procedure was introduced as a simplified approach for valve-sparing correction of functional Type I aortic insufficiency (AI) associated with aortic root aneurysms. In this study, short- and long-term outcomes after the FL Sleeve procedure were investigated.
Methods
From May 2002 to January 2016, 177 patients underwent the FL Sleeve procedure. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter, left ventricular ejection fraction, and degree of AI (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4) were evaluated by echocardiography.
Results
Mean ± standard deviation of age was 49.41 ± 15.37 years. Survival rate was 98% at 1 year, 97% at 5 years, and 93% at 8 years. Freedom from reoperation was 99% at 1 year and 98% at 2 to 8 years. Three patients (1.69%) died during hospitalization. Three patients (1.69%) developed periprocedural stroke. Postoperative follow-up echocardiography was available in 140 patients at 30 days, and 31 patients at 5 years. AI grade significantly improved from baseline at 30 days (2.18 ± 1.26 vs. 1.1 ± 0.93,
p
< 0.001) and at 5 years (2.0 ± 1.23 vs. 1.45 ± 0.88,
p
= 0.04). Preoperative mean LVEDD significantly decreased from 52.20 ± 6.73 to 46.87 ± 8.40 (
p
< 0.001) at 30 days, and from 53.22 ± 7.07 to 46.61 ± 10.51 (
p
= 0.01) at 5 years.
Conclusions
The FL Sleeve procedure is a safe, effective, and durable treatment of aortic root aneurysm and Type I AI. Long-term survival and freedom from reoperation rates are encouraging.
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Affiliation(s)
- Seyed Hossein Aalaei-Andabili
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.,Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Tomas D Martin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Philip J Hess
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Indiana University, Indianapolis, Indiana
| | - Ashkan Karimi
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Anthony A Bavry
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida.,North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
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10
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Saku K, Tobinaga S, Oryoji A, Fukuda T, Zaima Y, Saisho H, Shojima T, Takagi K, Takaseya T, Tanaka H. Florida sleeve technique for a right sinus of Valsalva aneurysm: a case report. Surg Case Rep 2019; 5:125. [PMID: 31385066 PMCID: PMC6682834 DOI: 10.1186/s40792-019-0682-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Florida sleeve technique was reported by Hess et al. as a new technique of valve sparing aortic root replacement without the requirement of entire aortic root wall resection and coronary artery reconstruction. We present a rare case of an unruptured aneurysm of the right sinus of Valsalva that was successfully treated with resection of the aneurysm and the Florida sleeve technique. CASE PRESENTATION A 72-year-old man was admitted for the treatment of an unruptured aneurysm of the right sinus of Valsalva. Computed tomography showed an aneurysm of the right sinus of Valsalva measuring > 40 mm and protruding into the right ventricular outflow tract. The aneurysm dilated up to 5 mm per year, and the left sinus of Valsalva and non-coronary sinus of Valsalva also showed dilation, and he underwent resection of only the right sinus of Valsalva aneurysm and valve sparing aortic root replacement with the Florida sleeve technique. CONCLUSIONS We performed valve-sparing aortic root replacement with the Florida sleeve technique. It could reduce surgical risks and prevent a dilatation of the residual sinus of Valsalva through coverage with a graft for a long term.
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Affiliation(s)
- Kosuke Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Satoru Tobinaga
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomofumi Fukuda
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuyuki Zaima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroyuki Saisho
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takahiro Shojima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tohru Takaseya
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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11
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Tasca G, Selmi M, Riva B, Lobiati E, Gamba A, Redaelli A, Votta E. Aortic Root Dynamics in Sleeve Aortic Sparing Procedure: Echocardiographic and Computational Studies. Semin Thorac Cardiovasc Surg 2019; 32:635-643. [PMID: 31356867 DOI: 10.1053/j.semtcvs.2019.07.010] [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: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 11/11/2022]
Abstract
In Sleeve procedure, the leaflets-sinus unit is maintained. We hypothesized that this feature partially preserves aortic root (AR) dynamics and leaflets kinematics and limits tensions in the leaflets. We tested our hypothesis based on in vivo and computational assessment of leaflets and AR dynamics. AR and aortic leaflet kinematics was assessed by transthoracic echocardiography in 10 patients treated with the Sleeve procedure and in 10 healthy patients. Numerical calculations with the Finite Element Method were performed to support the analysis of the clinical results and provide a better understanding of the behavior of the AR treated via the Sleeve procedure. Echocardiographic evidence showed that AR expansion in the Sleeve group was partially preserved as compared to the Control group (2.9 ± 2.5% vs 7.7 ± 6.3%, P = 0.038) and of the sinotubular junction (2.9 ± 1.5% vs 7.3 ± 3.8%, P = 0.003), and significantly preserved at the Valsalva sinuses level (6.7 ± 2.6% vs 9.5 ± 4.3%) with not statistically significant differences (P = 0.11). In none of the cardiac phases, differences in aortic valve leaflets kinematics were measured between the 2 groups; computational results were rather consistent with this evidence. Computational results well matched echocardiographic evidences, allowing for their mechanistic interpretation. Near-normal opening and closing characteristics can be accomplished by a technique that preserves the shape and the dynamics of the Valsalva sinuses. Whether the substantial preservation of the AR distensibility and leaflets kinematics observed in this study will favorably affect long-term valve durability it remains to be ascertained.
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Affiliation(s)
- Giordano Tasca
- Cardiovascular Department, Operative Units of Cardiac Surgery, Ospedale "A. Manzoni" ASST-Lecco, Lecco, Italy; Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milano, Italy.
| | - Matteo Selmi
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milano, Italy; Division of Cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy
| | - Beatrice Riva
- Cardiovascular Department, Operative Units of Cardiology, Ospedale "A. Manzoni" ASST-Lecco, Lecco, Italy
| | - Elisabetta Lobiati
- Cardiovascular Department, Operative Units of Cardiology, Ospedale "A. Manzoni" ASST-Lecco, Lecco, Italy
| | - Amando Gamba
- Cardiovascular Department, Operative Units of Cardiac Surgery, Ospedale "A. Manzoni" ASST-Lecco, Lecco, Italy
| | - Alberto Redaelli
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milano, Italy
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12
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Shehada SE, Benedik J, Serrano M, Lurbaski J, Demircioglu E, Wendt D, Jakob H, Mourad F. Modified sizing technique with newly designed tools to facilitate the valve sparing aortic root replacement "David" procedure with mid-term results. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 60:259-267. [PMID: 30465417 DOI: 10.23736/s0021-9509.18.10690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Valve sparing root replacement differs in specific points. The main target remains to achieve a perfect intraoperative result and long-term stability. We aimed in this study to present our modified sizing technique for valve-sparing "David" procedure and its mid-term results. METHODS We present a retrospective single-center study. A newly designed sizing ring in addition to triple-armed forceps (Trifeet®) was used to measure the proper size of the Valsalva® prosthesis for patients undergoing David-procedure. Primary endpoints are intraoperative aortic regurgitation (AR) and early postoperative outcomes. Secondary endpoints included freedom from aortic regurgitation or reoperation and overall mortality. RESULTS A total of 63 consecutive patients who underwent David procedure between 09/2012 and 12/2016 were evaluated. Mean age was 52±15 years and 76.2% were male. Moderate to severe aortic regurgitation was reported in 60 (95.2%) patients. Four (6.3%) patients presented with type-A aortic dissection, 20 (31.7%) patients had bicuspid and 3 (4.8%) had a unicuspid aortic valve, 2 (3.2%) patients had a prior aortic valve repair. Intraoperative echocardiography revealed no 34 (54%), trace 26 (41.2%) or moderate 3 (4.8%) AR. Stroke, myocardial infarction, and 30-day mortality occurred in 1 patient (1.6%). During follow-up 5 (7.9%) patients needed reoperation due to recurrent AR within a mean of 35±18 months. One could be re-repaired, and the other four underwent aortic valve replacement. A second patient died in the late follow-up. CONCLUSIONS Our modified sizing technique simplifies the "David-procedure" and allows to achieve a good intraoperative and mid-term results. However, these results have to be confirmed in a larger cohort with a long-term follow-up.
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Affiliation(s)
- Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany -
| | - Jaroslav Benedik
- Department of Cardiovascular Surgery, Helios Clinic Krefeld, Krefeld, Germany
| | - Maria Serrano
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Juri Lurbaski
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Ender Demircioglu
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Fanar Mourad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
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Dumfarth J, Grimm M. Invited Commentary. Ann Thorac Surg 2017; 104:839-840. [DOI: 10.1016/j.athoracsur.2017.02.004] [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: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
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14
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Aortic Root Replacement for Children With Loeys-Dietz Syndrome. Ann Thorac Surg 2017; 103:1513-1518. [DOI: 10.1016/j.athoracsur.2017.01.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/22/2022]
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Aortic Root Biomechanics After Sleeve and David Sparing Techniques: A Finite Element Analysis. Ann Thorac Surg 2017; 103:1451-1459. [DOI: 10.1016/j.athoracsur.2016.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/20/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
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Aalaei-Andabili SH, Martin T, Hess P, Klodell C, Karimi A, Arnaoutakis G, Lee T, Beaver T. Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function in Marfan Syndrome Patients. Ann Thorac Surg 2017; 104:834-839. [PMID: 28410640 DOI: 10.1016/j.athoracsur.2017.01.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/10/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Florida sleeve (FS) procedure was developed as a simplified approach for repair of functional type I aortic insufficiency secondary to aortic root aneurysm. We evaluated postoperative aortic valve function, long-term survival, and freedom from reoperation in Marfan syndrome patients who underwent the FS procedure at our center. METHODS All Marfan syndrome patients undergoing FS procedure from May 2002 to December 2014 were included. Echocardiography assessment included left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), ejection fraction, and degree of aortic insufficiency (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4). Social Security Death Index and primary care physicians' report were used for long-term follow-up. RESULTS Thirty-seven Marfan syndrome patients, 21 (56.8%) men and 16 (43%) women with mean age of 35.08 ± 13.45 years underwent FL repair at our center. There was no in-hospital or 30-day death or stroke. Two patients required reoperation due to bleeding. Patients' survival rate was 94% at 1 to 8 years. Freedom from reoperation was 100% at 8 years. Twenty-five patients had postoperative follow-up echocardiography at 1 week. Aortic insufficiency grade significantly decreased after the procedure (preoperative mean ± SD: 1.76 ± 1.2 versus 1-week postoperative mean ± SD: 0.48 ± 0.71, p < 0.001), and mean LVEDD decreased from 52.23 ± 5.29 mm to 47.53 ± 8.89 mm (p = 0.086). Changes in LVESD (35.33 ± 9.97 mm to 36.58 ± 9.82 mm, p = 0.58) and ejection fraction (57.65% ± 6.22% to 55% ± 10.83%, p = 0.31) were not significant. CONCLUSIONS The FS procedure can be performed safely in Marfan syndrome patients with immediate improvement in aortic valve function. Long-term survival and freedom from reoperation rates are encouraging.
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Affiliation(s)
| | - Tomas Martin
- Division of Thoracic and Cardiovascular Surgery, Florida Hospital Orlando, Orlando, Florida
| | - Philip Hess
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Indiana University, Indianapolis, Indiana
| | - Charles Klodell
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Ashkan Karimi
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida
| | - George Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Teng Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Thomas Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
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Patel ND, Crawford T, Magruder JT, Alejo DE, Hibino N, Black J, Dietz HC, Vricella LA, Cameron DE. Cardiovascular operations for Loeys-Dietz syndrome: Intermediate-term results. J Thorac Cardiovasc Surg 2016; 153:406-412. [PMID: 27955909 DOI: 10.1016/j.jtcvs.2016.10.088] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/02/2016] [Accepted: 10/05/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Early experience with Loeys-Dietz syndrome (LDS) suggested an aggressive aortopathy with high risk of aneurysm dissection and rupture at young ages and at smaller aortic diameters than in other connective tissue disorders. We reviewed our experience with LDS to re-examine our indications and outcomes of surgical management. METHODS We reviewed all patients with a diagnosis of LDS who underwent cardiovascular surgery at our institution. The primary endpoint was mortality, and secondary endpoints included postoperative complications and need for reintervention. RESULTS Seventy-nine operated patients with LDS were identified. Mean age at first operation was 25 years, 39 (49%) were female, and 38 (48%) were children (age <18 years). Six (8%) patients presented with acute dissection. Five (6%) patients had a bicuspid aortic valve, and all presented with an ascending aortic aneurysm with a mean root diameter of 3.5cm. Twenty (25%) patients had a previous sternotomy. Sixty-five (82%) patients underwent aortic root replacement, of whom 52 underwent a valve-sparing operation and 4 had concomitant arch replacement. Mean aortic root diameter in this group was 4.2 cm. Nine (11%) patients underwent aortic arch replacement, 2 (3%) had isolated ascending aorta replacement, and 3 (4%) underwent open thoracoabdominal repair. There were 2 (3%) operative and 8 late deaths. Nineteen patients underwent subsequent operations for late aneurysm and/or dissection. Mean follow-up was 6 years (range 0-24 years). Kaplan-Meier survival was 88% at 10 years. CONCLUSIONS Growing experience with LDS has confirmed early impressions of its aggressive nature and proclivity toward aortic catastrophe. Surgical outcomes are favorable, but reintervention rates are high. Meticulous follow-up with cardiovascular surveillance imaging remain important for management, particularly as clinical LDS subtypes are characterized and more tailored treatment is developed.
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Affiliation(s)
- Nishant D Patel
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Todd Crawford
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - J Trent Magruder
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Diane E Alejo
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Narutoshi Hibino
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - James Black
- Division of Vascular Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Harry C Dietz
- Department of Medicine, The McKusick-Nathans Institute of Genetic Medicine, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Luca A Vricella
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Duke E Cameron
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
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Settepani F, Cappai A, Raffa GM, Basciu A, Barbone A, Berwick D, Citterio E, Ornaghi D, Tarelli G, Malvindi PG. Cusp repair during aortic valve-sparing operation: technical aspects and impact on results. J Cardiovasc Med (Hagerstown) 2016; 16:310-7. [PMID: 24978873 DOI: 10.2459/jcm.0000000000000031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Aortic valve-sparing operations are nowadays considered safe and reliable procedures in terms of mid-term and long-term results. Although surgical techniques regarding the modality of grafts' implantation have been properly addressed, the modality of cusp repair, when needed, is still open to debate. We sought to review the literature to try to shed light on when the cusp repair is required and how it should be performed. METHODS We searched the PubMed database using the keywords aortic valve-sparing operation, aortic valve-sparing reimplantation, valve-sparing aortic root replacement, aortic valve repair, and aortic cusp repair. Only studies that included and described in detail the technique of cusp repairs in adjunct to aortic valve-sparing operation were considered. RESULTS Bicuspid aortic valve more often requires correction when compared with tricuspid valve. The range of the techniques varies from the 'simple' free margin plication to the more complex triangular resection with patch repair. Results in the literature seem to be encouraging, showing that, in most of the cases, cusp repair does not affect valve competence in the mid-term and long-term. CONCLUSION Correction of the cusp is a delicate balance between undercorrection that could lead to residual prolapse and overcorrection that could lead to cusp restriction. Although complex repair of the aortic valve in addition to root replacement provided satisfactory results, it should be reserved for experienced centers with a large volume of patients.
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Affiliation(s)
- Fabrizio Settepani
- Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Plonek T, Dumanski A, Obremska M, Kustrzycki W. First Beating-Heart Valve-Sparing Aortic Root Repair: A “Corset” Technique. Ann Thorac Surg 2015; 99:1464-6. [DOI: 10.1016/j.athoracsur.2014.11.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 09/27/2014] [Accepted: 11/24/2014] [Indexed: 10/23/2022]
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Hess P, Caranasos T, Siegal S, Klodell C, Beaver T, Martin T. Valve-sparing repair of aortic root aneurysms: an update on the Florida sleeve. Heart Surg Forum 2014; 17:E10-2. [PMID: 24631984 DOI: 10.1532/hsf98.2013259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aortic valve-sparing reimplantation remains an effective technique for repair of aortic root aneurysms. Studies indicate that the Florida Sleeve procedure is dimensionally stable and durable in the early postoperative period; however, our technique has evolved. We describe a 10-year institutional experience and the technical update of the Florida Sleeve repair for root aneurysms.
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Affiliation(s)
- Philip Hess
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Thomas Caranasos
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Steve Siegal
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Charles Klodell
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Thomas Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Tomas Martin
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
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Kim DH, Kim KS, Kim JB, Lee JW. Florida sleeve repair for aortic root aneurysm. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:353-6. [PMID: 24175270 PMCID: PMC3810557 DOI: 10.5090/kjtcs.2013.46.5.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/14/2013] [Accepted: 05/20/2013] [Indexed: 11/28/2022]
Abstract
A 74-year-old man was diagnosed with aortic root aneurysm and two-vessel coronary disease. Echocardiographic assessment revealed an enlarged sinus of Valsalva 60 mm in diameter with mild aortic regurgitation. Florida sleeve repair was performed using a vascular graft combined with coronary artery bypass grafting. The postoperative course was uncomplicated and follow-up echocardiographic evaluations showed an aortic root diameter of 38 mm without aortic insufficiency up to 1 year after surgery.
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Affiliation(s)
- Dong Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
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Heo W, Min HK, Kang DK, Jun HJ, Hwang YH, Choi JH, Wi JH. A modified root reinforcement technique for acute aortic dissection with a weakened aortic root: a modified Florida sleeve technique and two cases report. J Cardiothorac Surg 2013; 8:203. [PMID: 24172158 PMCID: PMC3826657 DOI: 10.1186/1749-8090-8-203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022] Open
Abstract
Despite marvelous advances in repair for acute type A aortic dissection over past decades, it remains challenging to repair the aortic root when aortic dissection extended to the sinuses causes the fragile root because of its thinner layers, which are susceptible to suture trauma. Here, we describe a modified Florida sleeve technique to strengthen the weakened aortic root. After mobilization of the aortic root and the coronary arteries, a designed Dacron tube graft was wrapped outside the sinuses as neo-adventitia to reinforce the dissected weakened wall. During surgery for aortic dissection, our technique is easy and effective to reinforce a weakened root and avoid bleeding. Furthermore, this might be an alternative technique to restore and maintain the geometry of the aortic root.
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Affiliation(s)
| | - Ho-Ki Min
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 (Jwadong) Haeundae-ro, Haeundaegu, Busan 612-030, Korea.
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Midterm Results of David Reimplantation in Patients With Connective Tissue Disorder. Ann Thorac Surg 2013; 95:555-62. [DOI: 10.1016/j.athoracsur.2012.08.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 07/24/2012] [Accepted: 08/01/2012] [Indexed: 11/18/2022]
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Komoda T, Komoda S, Gehle P, Berger F, Hammerschmidt R, Hetzer R, Huebler M. Reverse graft placement in the Florida sleeve procedure for aortic root aneurysm. Ann Thorac Surg 2013; 95:723-5. [PMID: 23336895 DOI: 10.1016/j.athoracsur.2012.09.013] [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: 05/02/2012] [Revised: 08/22/2012] [Accepted: 09/04/2012] [Indexed: 11/25/2022]
Abstract
Since August 2009, 22 patients with aortic root aneurysm have been successfully operated on with our new aortic remodeling technique as follows: after placement of the Gelweave (Vascutek, Ltd., Inchinnan, UK) Valsalva vascular graft in the reverse manner to the Florida sleeve procedure, the aortic annulus was fixed with the collar of this prosthesis at the level of the basal ring and the aortic root was wrapped with the prosthesis. Furthermore, the aortic valve commissures were resuspended. The distal end of the graft and the transected aortic wall were sutured together with running sutures when they were anastomosed to the stump of the distal ascending aorta.
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Affiliation(s)
- Takeshi Komoda
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
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David TE. Aortic valve sparing operations: a review. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:205-12. [PMID: 22880164 PMCID: PMC3413824 DOI: 10.5090/kjtcs.2012.45.4.205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 11/16/2022]
Abstract
Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.
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Affiliation(s)
- Tirone E David
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Canada
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Abstract
The aortic root has a unique 3-dimensional configuration and the distinctive function of supporting the aortic valve and blood vessels. The sinuses of Valsalva are crucial to create appropriate eddy currents that are important in initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Most aneurysms in the aortic root are associated with degenerative changes in the elastic media rather than atherosclerosis. Valve-sparing root repair has become widely accepted, although the Bentall procedure remains the gold standard. Because reimplantation using the Valsalva graft allows root geometry to be retained and theoretically and practically prevents recurrent aortic valve regurgitation, it is considered the most reliable and preferred technique among various valve-sparing aortic root repair procedures.
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Affiliation(s)
- Hideyuki Shimizu
- Division of Cardiovascular Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan.
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Aortic root aneurysm: principles of repair and long-term follow-up. J Thorac Cardiovasc Surg 2010; 140:S14-9; discussion S45-51. [PMID: 21092781 DOI: 10.1016/j.jtcvs.2010.07.041] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/12/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study was undertaken to examine clinical and echocardiographic outcomes of aortic valve-sparing operations to treat aortic root aneurysms. METHODS From May 1988 to December 2007, a total of 228 patients underwent reimplantation of the aortic valve, and 61 underwent remodeling of the aortic root. Patients were followed up prospectively and had echocardiographic evaluation of valve function. Mean follow-up was 7.28 ± 4.33 years. RESULTS There were 5 operative and 26 late deaths. Survival at 12 years was 82.9 ± 3.7% and similar between types of operations. Age and aortic dissection were independent predictors of mortality. Seven patients have had reoperations on the aortic valve: 6 for aortic insufficiency and 1 for endocarditis. Five of these patients had undergone remodeling of the aortic root. Freedoms from reoperation at 12 years were 94.3% ± 2.6% among all patients, 90.4% ± 4.7% after remodeling, and 97.4% ± 2.2% after reimplantation (P = .09). Postoperatively, moderate aortic insufficiency developed in 14 patients (8 remodeling and 6 reimplantation) and severe aortic insufficiency in 5 (3 remodeling and 2 reimplantation). The remaining patients had mild, trace, or no aortic insufficiency. Freedoms from moderate or severe aortic insufficiency at 12 years were 86.8% ± 3.8% among all patients, 82.6% ± 6.2% after remodeling, and 91.0% ± 3.8% after reimplantation (P = .035). Only age-by 5-year increments-was an independent predictor of postoperative aortic insufficiency. CONCLUSIONS Aortic valve-sparing operations provide excellent patient survival and stable aortic valve function, particularly after reimplantation of the aortic valve.
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Simplified David Reimplantation With Reduction of Anular Size and Creation of Artificial Sinuses. Ann Thorac Surg 2010; 89:1443-7. [DOI: 10.1016/j.athoracsur.2010.01.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/18/2010] [Accepted: 01/20/2010] [Indexed: 11/17/2022]
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Hetzer R, Komoda T, Komoda S, Berger F, Huebler M. New aortic root remodeling surgery in aortic root aneurysm. Ann Thorac Surg 2010; 89:1260-4. [PMID: 20338348 DOI: 10.1016/j.athoracsur.2009.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 12/11/2009] [Accepted: 12/15/2009] [Indexed: 01/06/2023]
Abstract
PURPOSE We have introduced a new surgical technique for aortic root remodeling in aortic root aneurysm, comprised of aortic annuloplasty, reduction of sinus of Valsalva, and wrapping of the aortic root. DESCRIPTION At the level of the basal ring, the aortic annulus is fixed with the collar of a Gelweave Valsalva vascular graft (Vascutek, Ltd, Inchinnan, UK). After plication of the dilated sinuses of Valsalva from outside the aorta, the aortic root is wrapped with this prosthesis. The distal end of the graft and the transected aortic wall are sutured together with running sutures. EVALUATION Since September 2006, 10 patients suffering from aortic root aneurysm were successfully operated on using this technique. After a median follow-up of 20.7 months, there were no early deaths and no reoperations due to failure of remodeling surgery. Median diameter of the sinus of Valsalva was reduced from 49.5 mm to 34.0 mm. All patients showed aortic regurgitation of grade 0 or grade 1 at follow-up. CONCLUSIONS Long-term follow-up is necessary to prove the durability of this operation.
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Affiliation(s)
- Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
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Promising Early Results of Periaortic Root Remodeling With the Valsalva Graft: Letter 1. Ann Thorac Surg 2010; 89:342-3; author reply 343-4. [DOI: 10.1016/j.athoracsur.2009.06.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 04/30/2009] [Accepted: 06/30/2009] [Indexed: 11/21/2022]
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Hess PJ, Harman PK, Klodell CT, Beaver TM, Tribble CG, Martin TD. Reply. Ann Thorac Surg 2010. [DOI: 10.1016/j.athoracsur.2009.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Izumoto H. The Florida Sleeve Repair: Letter 2. Ann Thorac Surg 2010; 89:343; author reply 343-4. [DOI: 10.1016/j.athoracsur.2009.06.101] [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: 05/24/2009] [Revised: 05/24/2009] [Accepted: 06/30/2009] [Indexed: 11/27/2022]
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Castro HC, Zingali RB, Albuquerque MG, Pujol-Luz M, Rodrigues CR. Snake venom thrombin-like enzymes: from reptilase to now. Cell Mol Life Sci 2004; 61:843-56. [PMID: 15095007 PMCID: PMC11138602 DOI: 10.1007/s00018-003-3325-z] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The snake venom thrombin-like enzymes (SVTLEs) comprise a number of serine proteases functionally and structurally related to thrombin. Until recently, only nine complete sequences of this subgroup of the serine protease family were known. Over the past 5 years, the primary structure of several SVTLEs has been characterized, and now this family includes several members. Of particular interest is their possible use in pathologies such as thrombosis. The aim of the present review is to summarize the state of the art concerning the evolutionary, structural and biological features of the SVTLEs.
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Affiliation(s)
- H C Castro
- Departamento de Biologia Celular e Molecular, IB-CEG, Universidade Federal Fluminense, Niterói, 24001-970 Rio de Janeiro, Brazil.
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