1
|
Patel PM, Levine D, Dong A, Yamabe T, Wei J, Binongo J, Leshnower BG, Takayama H, Chen EP. True redo-aortic root replacement versus root replacement after any previous surgery. JTCVS OPEN 2023; 16:167-176. [PMID: 38204664 PMCID: PMC10775063 DOI: 10.1016/j.xjon.2023.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 01/12/2024]
Abstract
Objective The impact of previous aortic root replacement (True-Redo) versus any previous operation (Any-Redo) on outcomes after reoperative aortic root replacement (redo-ROOT) is largely unknown. In this first multi-institutional study, the clinical impact True-Redo versus Any-Redo in the setting of redo-ROOT was reviewed. Methods From 2004 to 2021, 822 patients underwent redo-ROOT at 2 major academic centers: 638 Any-Redo and 184 True-Redo. Matching based on preoperative demographics and concomitant operations resulted in 174 matched pairs. An independent risk factor analysis was performed to determine risk factors for early and late mortality. Results Patients in the True-Redo group were younger, at 49.9 ± 15.1 versus 55.3 ± 14.7 years, P < .001. Concomitant operations were largely similar between the 2 groups, P > .05. Median cardiopulmonary bypass time (P < .001) and aortic crossclamp time (P = .03) were longer for True-Redo group. In-hospital mortality was 13% (109) and was without significant difference between groups, P = .41. Ten-year survival was 78% versus 76% for True-Redo versus Any-Redo groups respectively, P = .7. Landmark survival analysis at 4 years' postoperatively on the matched groups found that patients in the True-Redo group had improved survival outcomes (P = .046). Risk factors of in-hospital mortality consisted of older age (P < .0001), lower ejection fraction (P = .02), and male patient (P = .0003). Conclusions Clinical outcomes following redo-ROOT are excellent. Performance of a True-Redo-ROOT does not result in worse in-hospital morbidity or mortality and has improved survival benefit at midterm follow-up when compared with patients in the Any-Redo group. The decision to perform a redo-ROOT must be taken seriously and must be individualized in a patient-specific manner for optimal outcomes.
Collapse
Affiliation(s)
- Parth M. Patel
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Dov Levine
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Andy Dong
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Tsuyoshi Yamabe
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Jane Wei
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Jose Binongo
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Bradley G. Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Hiroo Takayama
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Edward P. Chen
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, NC
| |
Collapse
|
2
|
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
3
|
Saul D, Kandula V, Donuru A, Pizarro C, Harty MP. Large aortic pseudoaneurysm after Bentall procedure in a patient with Marfan's syndrome. Ann Pediatr Cardiol 2022; 15:314-316. [PMID: 36589649 PMCID: PMC9802612 DOI: 10.4103/apc.apc_113_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/30/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
An 11-year-old male with Marfan's syndrome and aortic root dilatation underwent an uneventful Bentall procedure to replace his aortic root and valve. Five months later, surveillance echocardiogram revealed a slowly enlarging pseudoaneurysm arising from the ascending aorta. This finding was subsequently confirmed by computed tomographic angiogram. The patient had successful open surgical repair and paraaortic hematoma evacuation.
Collapse
Affiliation(s)
- David Saul
- Department of Medical Imaging, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Vinay Kandula
- Department of Medical Imaging, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Achala Donuru
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Christian Pizarro
- Department of Surgery, Division of Cardiothoracic Surgery, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Mary Patricia Harty
- Department of Medical Imaging, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| |
Collapse
|
4
|
Slisatkorn W, Sanphasitvong V, Luangthong N, Kaewsaengeak C. Tips and tricks in redo aortic surgery. Indian J Thorac Cardiovasc Surg 2022; 38:163-170. [PMID: 35463713 PMCID: PMC8980975 DOI: 10.1007/s12055-021-01322-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022] Open
Abstract
Redo aortic surgery is challenging, and the operative risk is higher than that in primary aortic surgery. Preoperative imaging is a crucial guide for a safe re-entry. Scrutinized preparing in cannulation and organ protection strategies have affected surgical outcomes. With comprehensive planning and meticulously executed surgery, mortality and morbidity can be acceptable. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-021-01322-x.
Collapse
Affiliation(s)
- Worawong Slisatkorn
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Vutthipong Sanphasitvong
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Nutthawadee Luangthong
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | | |
Collapse
|
5
|
Deng J, Zhong Q. Clinical analysis of redo aortic root replacement after cardiac surgery: a retrospective study. J Cardiothorac Surg 2021; 16:202. [PMID: 34321011 PMCID: PMC8316709 DOI: 10.1186/s13019-021-01587-8] [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: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To explore the etiology, previous cardiac procedure methods and outcomes of redo aortic root replacement after cardiac surgery. Methods A retrospective analysis of 41 patients who underwent aortic root replacement surgery in our hospital from February 2010 to February 2020 who underwent at least one cardiac surgery in the past, including 27 males and 14 females, with an average age of 49.5 ± 10.2 years old. Indications for reoperation include: aortic sinus dilation and ascending aortic aneurysm in 20 cases (48.8%), recurrent aortic dissection in 7 cases (17.1%), pseudoaneurysm of aortic root in 4 cases (9.8%), prosthetic valve endocarditis in 5 cases (12.2%) and paravalvular leakage in 5 cases (12.2%). According to whether the previous procedure involved aortic root surgery, they were divided into 2 groups, namely aortic root surgery-involved (ARS) group and non-aortic root surgery-involved (NRS) group. After the patients were discharged from hospitals, follow-ups were carried out through outpatient clinic or telephone for 5 years. Kaplan-Meier was used for survival analysis. Results All patients underwent Bentall procedure with a median sternum incision. Six patients (14.6%) died during the postoperative hospitalization and 3 patients (8.6%) died during the follow-up. The 1-year, 3-year, and 5-year survival in ARS group were 92.6, 92.6, and 92.6%, respectively; the 1-year, 3-year, and 5-year survival in NRS group were 100, 85.7, and 85.7%, respectively. There was no statistical difference between the two groups in the cause of redo aortic root replacement, procedure time, postoperative complications, postoperative hospital stay, hospital mortality, and 5-year cumulative survival (p > 0.05). Conclusions Redo aortic root replacement is difficult and high risk. Bentall procedure is still a reliable surgical option for redo aortic root replacement, with good short- and mid-term results. The prognosis of redo aortic root replacement is not necessarily related to the etiology of patient’s surgery and the methods of previous cardiac procedure.
Collapse
Affiliation(s)
- Jianying Deng
- Department of Cardiovascular Surgery, Chongqing Kanghua Zhonglian Cardiovascular Hospital, 168 Haier Street, Jiangbei District, Chongqing, 400015, China.
| | - Qianjin Zhong
- Department of Cardiovascular Surgery, Army Medical Center of PLA, Chongqing, 400020, China
| |
Collapse
|
6
|
Lou X, Leshnower BG, Binongo J, Beckerman Z, McPherson L, Chen EP. Re-Operative Aortic Arch Surgery in a Contemporary Series. Semin Thorac Cardiovasc Surg 2021; 34:377-382. [PMID: 33971297 DOI: 10.1053/j.semtcvs.2021.03.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022]
Abstract
Re-operative aortic arch operations (REDO) following previous cardiac surgery are challenging procedures associated with significant morbidity and mortality. We investigated post-operative outcomes for patients undergoing REDO and identified risk-factors for mortality in a contemporary series. From 1/2005-6/2018, 365 consecutive patients at an academic center underwent REDO: 257 HEMIARCH and 108 COMPLETE arch (45 stage I elephant trunk, 63 total arch) replacements. Outcomes included mortality and major adverse events. Long-term survival was determined with Kaplan-Meier analysis, and risk-factors for mortality were assessed with Cox proportional hazards regression. Operative mortality for the entire cohort was 6.8%, and rates of stroke, cardiac arrest, and renal failure were 6.0%, 7.4%, and 10.4%. Compared to HEMIARCH, COMPLETE patients had an increased incidence of renal failure requiring dialysis (15.7% vs 8.2%, p = 0.031) and re-exploration for bleeding or delayed chest closure (19.4% vs. 11.7%, p = 0.051). Although operative mortality was similar in both cohorts, long-term follow-up mortality (38.0% vs 26.8%, p = 0.047) was higher among COMPLETE vs. HEMIARCH. Predictors of overall mortality among all-comers undergoing REDO included older age, low body surface area, endocarditis, ejection fraction <30%, emergent status of operation, extended cardiopulmonary bypass duration, intra-aortic balloon pump use, and a more extensive arch operation. Previous aortic surgery was not a risk-factor for mortality. Among all-comers undergoing REDO, survival was 81.4% at 1 year, 66.7% at 5 years, and 56.4% at 10 years of follow-up. While early postoperative outcomes are similar among HEMIARCH and COMPLETE, a more extensive arch-replacement is an independent risk-factor for overall mortality in REDO. Using appropriate clinical indications in the current era, REDO remains a viable option for selected patients.
Collapse
Affiliation(s)
- Xiaoying Lou
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose Binongo
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ziv Beckerman
- Dell Children's Medical Center, The University of Texas at Austin
| | - LaRonica McPherson
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
7
|
Hage F, Hage A, Dagenais F, Cartier A, Ouzounian M, Chung J, El-Hamamsy I, Chauvette V, Peterson MD, Lachapelle K, Ridwan K, Boodhwani M, Guo M, Bozinovski J, Moon MC, White A, Yamashita M, Lodewyks C, Atoui R, Payne D, Chu MWA. Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative. Eur J Cardiothorac Surg 2021; 60:623-630. [PMID: 33769490 DOI: 10.1093/ejcts/ezab125] [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: 08/15/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair. METHODS A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed. RESULTS A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P < 0.001) and had less females (23% vs 35%, P < 0.001), less dissection (31% vs 36%, P = 0.004), less urgent cases (35% vs 39%, P = 0.047), more connective tissue disease (7% vs 3%, P < 0.001) and less total arch replacements (14% vs 22%, P < 0.001). On adjusted analyses, the addition of aortic root procedure was associated with increased mortality [MV: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03-1.92; PS-IPTW: risk increased by 3.7%, 95% CI 1.2-6.3%, P = 0.004]. Reoperation for bleeding was also increased with the addition of aortic root intervention (MV: OR 1.48, 95% 1.10-1.99; PS-IPTW: risk increased by 3.2%, 95% CI 0.8-5.6%, P = 0.009). The risks of stroke and dialysis-dependent renal failure were similar. When looking only at non-elective cases, the increased risk of mortality was more pronounced (MV: OR 1.60, 95% CI 1.11-2.32, P = 0.013; PS-IPTW: risk increased by 6.8%, 95 CI 1.7-11.8%, P = 0.008, and a number need to harm of 15 patients to cause 1 additional death). CONCLUSIONS The addition of aortic root replacement or sinus repair during proximal or total aortic arch repair seems to increase postoperative mortality only in non-elective cases.
Collapse
Affiliation(s)
- Fadi Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Francois Dagenais
- Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Andreanne Cartier
- Division of Cardiac Surgery, Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Vincent Chauvette
- Division of Cardiac Surgery, Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kevin Lachapelle
- Division of Cardiac Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Khalid Ridwan
- Division of Cardiac Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Ming Guo
- Division of Cardiac Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - John Bozinovski
- Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Abigail White
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael Yamashita
- Division of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Carly Lodewyks
- Division of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Rony Atoui
- Division of Cardiac Surgery, Department of Surgery, Health Sciences North, Sudbury, ON, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada
| | | |
Collapse
|
8
|
Dun Y, Shi Y, Guo H, Liu Y, Qian X, Sun X, Yu C. Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement. J Thorac Dis 2021; 13:1531-1542. [PMID: 33841945 PMCID: PMC8024838 DOI: 10.21037/jtd-20-3081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background There are limited data regarding the clinical outcomes of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement (AVR). We aimed to analyze outcomes of reoperative aortic root or ascending aorta replacement after prior AVR. Methods Eighty patients with prior AVR underwent reoperative aortic root or ascending aorta replacement in our hospital. The indications were root or ascending aortic aneurysm in 36 patients, root or ascending aortic dissection in 37, root false aneurysm in 2, prosthesis valve endocarditis (PVE) with root abscess in 2, Behçet’s disease (BD) with root destruction in 3 patients. An elective surgery was performed in 63 patients and an emergent surgery in 17. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test. Results The operative techniques included ascending aorta replacement in 14 patients, ascending aorta replacement with AVR in 3, prosthesis-sparing root replacement (PSRR) in 35, Bentall procedure in 24, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/80). A composite of adverse events occurred in 5 patients, including 1 operative death, 2 stroke and 3 renal failure necessitating hemodialysis. The mean follow-up was 35.5±22.1 months. Five late deaths occurred. The Kaplan-Meier survival at 1 year, 3 years and 6 years were 97.5%, 91.1% and 84.1%, respectively. Aortic events developed in 3 patients. The freedom from aortic events at 1-year, 3-year, and 6-year were 100%, 96.3% and 88.9%, respectively. There were no differences in survival and freedom from aortic events between the elective group and the emergent group. Conclusions Reoperative aortic root or ascending aorta replacement after prior AVR could be performed to treat the root or ascending pathologies after AVR, with satisfactory early and midterm outcomes.
Collapse
Affiliation(s)
- Yaojun Dun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Shi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanxiang Liu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyang Qian
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cuntao Yu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
9
|
Abe N, Okada K, Tanaka H, Okita Y. Valve-sparing aortic root replacement after type A aortic dissection repairs. Asian Cardiovasc Thorac Ann 2020; 29:381-387. [PMID: 33249852 DOI: 10.1177/0218492320977981] [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: 11/17/2022]
Abstract
OBJECTIVE Aortic root reoperation after aortic dissection repair sometimes requires aortic root replacement. A valve-preserving technique should be applied when the aortic cusp is normal. Valve-sparing aortic root reconstruction using the reimplantation technique resolves aortic valve regurgitation, root dilatation, and pseudoaneurysm in the proximal anastomosis. Our experience in aortic root reoperation is presented. METHODS From January 2000 to March 2019, 26 patients underwent reoperative valve-sparing aortic root reconstruction using the reimplantation technique. The time from the initial operation to reoperation was 69.3 ± 51.6 months. Aortic root reoperation was required for a fragile wall at the previous proximal anastomosis or aortic root dilatation. We aimed to stabilize the aortic root without valve regurgitation. The native aortic cusp was aggressively preserved when nearly normal. Indications included root dilatation (n = 13), pseudoaneurysm of the previous proximal anastomosis (n = 11), and aortic valve regurgitation (n = 4). RESULTS There was no early postoperative mortality. Follow-up was 49 ± 47 months (range 4-161 months). The 3, 5, and 10-year survival was 88.9% ± 7.4%, 88.9% ± 7.4%, and 77.8% ± 12.2%, respectively. Freedom from recurrence of a greater than moderate degree of aortic valve regurgitation at 3, 5, and 10 years was 86.5% ± 8.9%, 86.5% ± 8.9%, and 86.5% ± 8.9%, respectively. One patient underwent aortic valve replacement for recurrent aortic valve regurgitation 15 months after the valve-sparing reoperation. CONCLUSIONS Midterm outcomes of reoperative valve-sparing aortic root reconstruction using the reimplantation technique and postoperative aortic valve performance were satisfactory.
Collapse
Affiliation(s)
- Noriyuki Abe
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
10
|
Zhou Z, Liang M, Huang S, Wu Z. Reimplantation versus remodeling in valve-sparing surgery for aortic root aneurysms: a meta-analysis. J Thorac Dis 2020; 12:4742-4753. [PMID: 33145047 PMCID: PMC7578473 DOI: 10.21037/jtd-20-1407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Valve-sparing aortic root replacement (VSARR), which includes reimplantation and remodeling techniques, has been developed as an important treatment for aortic root aneurysms. We aimed to evaluate the outcomes of reimplantation versus remodeling techniques in valve-sparing surgery for aortic root aneurysms. Methods A systematic review and meta-analysis was performed by searching PubMed, Embase and the Cochrane Library until November 2019. Fourteen retrospective cohort studies comparing reimplantation with remodeling techniques for aortic root aneurysms were included and contained at least one of the following outcomes: early mortality, late mortality, aortic valve-related reoperation, and postoperative moderate to severe aortic regurgitation (AR). Results The outcomes of 1,672 patients (1,011 underwent reimplantation surgery, and 661 underwent remodeling) were analyzed. Compared with remodeling, the reimplantation technique was associated with a significantly lower risk of late mortality (RR =0.34; 95% CI, 0.17–0.71; P=0.004; I2=37%) and reoperation (RR =0.31; 95% CI, 0.12–0.76; P=0.01; I2=55%). There was no significant difference in early mortality (RR =0.69; 95% CI, 0.31–1.53; P=0.36; I2=0%), postoperative moderate to severe AR (RR =0.64; 95% CI, 0.31–1.32; P=0.22; I2=36%) or postoperative stroke (RR =1.26; 95% CI, 0.58–2.75; P=0.56; I2=0%) between the two groups. No evidence of publication bias was detected. Conclusions The current meta-analysis indicate that patients who undergo reimplantation procedures have a significantly lower risk of late mortality and reoperation than those who undergo remodeling procedures. Early mortality, postoperative moderate to severe AR and stroke were comparable between the two techniques.
Collapse
Affiliation(s)
- Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Mengya Liang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Suiqing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
11
|
Greco R, Muretti M, Djordjevic J, Jin XY, Hill E, Renna M, Petrou M. Surgical Complexity and Outcome of Patients Undergoing Re-do Aortic Valve Surgery. Open Heart 2020; 7:e001209. [PMID: 32201590 PMCID: PMC7076261 DOI: 10.1136/openhrt-2019-001209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/28/2020] [Accepted: 02/17/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Re-do aortic valve surgery carries a higher mortality and morbidity compared with first time aortic valve replacement (AVR) and often requires concomitant complex procedures. Transcatheter aortic valve replacement (TAVR) is an option for selective patients. The aim of this study is to present our experience with re-do aortic valve procedures and give an insight into the characteristics of these patients and their outcomes. Methods Retrospective review of 80 consecutive re-do aortic valve procedures. Results Mean patients’ age was 51.80±18.73 years. Aortic regurgitation (AR) was present in 51 (65.4%) patients and aortic stenosis (AS) in 38 (48.7%). Indications for reoperation were: infective endocarditis (IE) (23.8%), bioprosthetic degeneration (12.5%), mechanical valve dysfunction (5%), paravalvular leak (6.2%), patient–prosthesis mismatch (3.8%), native valve disease (25%), aortic aneurysm, pseudoaneurysm and dissection (35%), aortic root/homograft degeneration (27.5%). Forty-one (51.2%) patients underwent re-do AVR, 39 (48.8%) re-do complex aortic valve surgery (28 root, 23 ascending aorta and 6 hemiarch procedures) and 37.5% concomitant procedures. A bioprosthesis was implanted in 43.8%, a mechanical valve in 37.5%, a composite graft in 2.5%, a Biovalsalva graft in 6.2% and a homograft in 10% of patients. In-hospital mortality was 3.8% and incidence of major complications was low. Conclusions A significant proportion of patients were young (61%<60 y), required complex aortic procedures (49%) or presented with contraindications for TAVR (mechanical valve, AR, IE, proximal aortic disease, need for concomitant surgery). Re-do aortic surgery remains the only treatment for such challenging cases and can be performed with acceptable mortality and morbidity in a specialised aortic centre.
Collapse
Affiliation(s)
- Renata Greco
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mirko Muretti
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jasmina Djordjevic
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Xu Yu Jin
- Department of Cardiac Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nulfield Division of Clinical Lab Sciences, Oxford University, Oxford, UK
| | - Elaine Hill
- Department of Cardiothoracic Anaesthesia, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maurizio Renna
- Department of Cardiothoracic Anaesthesia, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mario Petrou
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Kouchoukos NT, Masetti P, Stamou SC, Kulik A, Haynes M. Outcomes After Left Ventricular Outflow Tract Reconstruction With a Tube Graft for Annular Erosion. Ann Thorac Surg 2019; 109:1820-1825. [PMID: 31697908 DOI: 10.1016/j.athoracsur.2019.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/12/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Aortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement. This study examined the outcomes of a technique for left ventricular outflow tract reconstruction using a polyester tube graft, followed by translocation of the aortic valve and coronary arteries. METHODS A total of 23 patients with extensive annular erosion resulting from endocarditis or previous aortic valve replacement with or without pseudoaneurysm formation, or occurring after excision of the native valve, underwent suture of a polyester tube graft in the left ventricular outflow tract below the annulus, replacement of the aortic valve and proximal ascending aorta with a composite graft, and reimplantation of the coronary arteries with the use of interposition polyester grafts. The mean age of the patients was 50 years, and 57% were men. RESULTS There were no hospital deaths. The mean duration of follow-up was 6.5 years and extended to 16 years. Actuarial survival at 1, 5, and 10 years was 86.7%, 82.2%, and 62.6%, respectively. Two patients required reoperation for a graft-graft pseudoaneurysm and for degeneration of a porcine bioprosthesis. Echocardiograms obtained at a mean of 75 months postoperatively in 15 of the 23 patients demonstrated normal left ventricular outflow tract dimensions and velocities and a mean effective valve orifice area of 1.07 cm2/m2. All coronary artery grafts were patent on angiography a mean of 40 months postoperatively in 13 patients. CONCLUSIONS Extended experience with this technique confirms its safety and effectiveness for patients with extensive destruction of the aortic annulus. It represents a suitable alternative to other currently used techniques.
Collapse
Affiliation(s)
- Nicholas T Kouchoukos
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri.
| | - Paolo Masetti
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| | - Sotiris C Stamou
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| | - Alexander Kulik
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| | - Marc Haynes
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| |
Collapse
|
13
|
Antoniou A, Bashir M, Harky A, Di Salvo C. Redo proximal thoracic aortic surgery: challenges and controversies. Gen Thorac Cardiovasc Surg 2018; 67:118-126. [DOI: 10.1007/s11748-018-0941-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/13/2018] [Indexed: 10/16/2022]
|
14
|
Manenti A, Zizzo M, Fedeli C, Caprili L. Coronary Artery Pseudoaneurysm After Bentall Procedure. Ann Thorac Surg 2017; 102:1409. [PMID: 27645951 DOI: 10.1016/j.athoracsur.2016.02.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/20/2016] [Accepted: 02/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio Manenti
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy.
| | - Maurizio Zizzo
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy
| | - Corrado Fedeli
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy
| | - Luca Caprili
- Department of Surgery, University of Modena, Policlinico Hospital, via Pozzo, 71, 41124 Modena, Italy
| |
Collapse
|
15
|
Berretta P, Di Marco L, Pacini D, Cefarelli M, Alfonsi J, Castrovinci S, Di Eusanio M, Di Bartolomeo R. Reoperations versus primary operation on the aortic root: a propensity score analysis. Eur J Cardiothorac Surg 2017; 51:322-328. [PMID: 28186292 DOI: 10.1093/ejcts/ezw250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/09/2016] [Accepted: 06/22/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paolo Berretta
- Division of Cardiac Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Luca Di Marco
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Mariano Cefarelli
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | - Jacopo Alfonsi
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| | | | - Marco Di Eusanio
- Division of Cardiac Surgery, "G. Mazzini" Hospital, Teramo, Italy
| | - Roberto Di Bartolomeo
- Department of Cardiac Surgery, S.Orsola-Malpighi-Hospital-University of Bologna, Bologna, Italy
| |
Collapse
|
16
|
Iribarne A, Keenan J, Benrashid E, Wang H, Meza JM, Ganapathi A, Gaca JG, Kim HW, Hurwitz LM, Hughes GC. Imaging Surveillance After Proximal Aortic Operations: Is it Necessary? Ann Thorac Surg 2016; 103:734-741. [PMID: 27677566 DOI: 10.1016/j.athoracsur.2016.06.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Current guidelines for imaging surveillance after proximal aortic repair are not evidence based. This study sought to characterize the incidence and causes of reintervention after proximal aortic operations to provide data to guide the frequency and duration of postoperative surveillance. METHODS Data on all patients undergoing proximal aortic operations (ascending, with or without root, with or without aortic valve replacement, or with or without arch) during a 9-year period (n = 869) at a single institution were prospectively collected. Patients who required reintervention on the proximal or distal aorta were identified and causes for reintervention determined. Planned two-stage repairs and index procedures done at other hospitals were excluded. The primary end point was the time to the first reintervention, and competing-risk Cox regression was used to model reintervention risk. RESULTS Reinterventions occurred in 4.3% of patients (n = 37), with 48.6% (n = 18) involving the proximal aorta and 51.4% (n = 19) the distal. Median time to reintervention was 2.8 years (interquartile range, 1.5 to 3.6 years). For index aneurysm cases, reintervention for aneurysm of the descending/thoracoabdominal aorta and root were most common. Of the 6 root aneurysms/pseudoaneurysms, 5 (83%) were due to degeneration of a stentless porcine aortic root. For index type A dissections, reintervention for aneurysm of the descending/thoracoabdominal aorta and arch were most common. The mean duration of follow up was 4.2 ± 2.5 years. The 9-year actuarial freedom from reintervention was 92.9%. Cox regression showed index type A dissection was a significant predictor of time to aortic reintervention (hazard ratio, 2.01; 95% confidence interval, 1.04 to 3.9; p = 0.038). CONCLUSIONS Reinterventions after proximal aortic operations are uncommon; most occur within 3 years of the index operation and involve the proximal and distal aorta nearly equally. Patients with type A dissection or stentless porcine roots require aggressive surveillance, whereas a more liberal approach is suitable for patients without such risk factors. This strategy may reduce the lifetime radiation burden and health care costs.
Collapse
Affiliation(s)
- Alexander Iribarne
- Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jeffrey Keenan
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Hanghang Wang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - James M Meza
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Asvin Ganapathi
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Han W Kim
- Division of Cardiology, Duke Cardiovascular Magnetic Resonance Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lynne M Hurwitz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| |
Collapse
|
17
|
Cabasa A, Pochettino A. Surgical management and outcomes of type A dissection-the Mayo Clinic experience. Ann Cardiothorac Surg 2016; 5:296-309. [PMID: 27563542 DOI: 10.21037/acs.2016.06.01] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated-such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes. METHODS All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method. RESULTS Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support post-operatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study. DISCUSSION TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the short and long term.
Collapse
Affiliation(s)
- Alduz Cabasa
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Pochettino
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
18
|
Sherrah AG, Jeremy RW, Puranik R, Bannon PG, Hendel PN, Bayfield MS, Wilson MK, Brady PW, Marshman D, Mathur MN, Brereton RJ, Edwards JR, Stuklis RG, Worthington M, Vallely MP. Long Term Outcomes Following Freestyle Stentless Aortic Bioprosthesis Implantation: An Australian Experience. Heart Lung Circ 2015; 25:82-8. [PMID: 26146198 DOI: 10.1016/j.hlc.2015.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/30/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results. METHODS A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals. Follow-up data included clinical and echocardiographic outcomes. RESULTS The cohort was 81.4% male with age 63.2±13.0 years and was followed for a mean of 2.4±2.3 years (range 0-10.9 years, total 569 patient-years). The FSB was implanted as a full aortic root replacement in 87.8% patients. The 30-day all cause mortality was 4.2% (2.0% for elective surgery). Cumulative survival at one, five and 10 years was 91.7±1.9%, 82.8±3.8% and 56.5±10.5%, respectively. Freedom from re-intervention at one, five and 10 years was 99.5±0.5%, 91.6±3.7% and 72.3±10.5%, respectively. At latest echocardiographic review (mean 2.3±2.1 years post-operatively), 92.6% had trivial or no aortic regurgitation. Predictors of post-operative mortality included active endocarditis, acute aortic dissection and peripheral vascular disease. CONCLUSIONS We report acceptable short and long term outcomes following FSB implantation in a cohort of comparatively younger patients with thoracic aortic disease. The durability of this bioprosthesis in the younger population remains to be confirmed.
Collapse
Affiliation(s)
- Andrew G Sherrah
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia
| | - Richmond W Jeremy
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rajesh Puranik
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Paul G Bannon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - P Nicholas Hendel
- The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Matthew S Bayfield
- The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael K Wilson
- The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Peter W Brady
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - David Marshman
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Manu N Mathur
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - R John Brereton
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - James R Edwards
- Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert G Stuklis
- Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael Worthington
- Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael P Vallely
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
| |
Collapse
|
19
|
Malaisrie SC, Duncan BF, Mehta CK, Badiwala MV, Rinewalt D, Kruse J, Li Z, Andrei AC, McCarthy PM. The addition of hemiarch replacement to aortic root surgery does not affect safety. J Thorac Cardiovasc Surg 2015; 150:118-24.e2. [PMID: 25896462 DOI: 10.1016/j.jtcvs.2015.03.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/27/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A hemiarch reconstruction, using deep hypothermic circulatory arrest, is the conventional approach for proximal aortic arch reconstruction, but it carries risks of neurologic events and coagulopathy. The addition of a hemiarch reconstruction to an aortic root replacement may prevent future aortic arch pathology. Outcomes of this approach at a tertiary care institution were examined to determine whether the addition of a hemiarch reconstruction to an aortic root replacement conferred any additional risk. METHODS A total of 384 patients underwent an aortic root replacement between April 2004 and June 2012. Of them, 177 (46%) had hemiarch replacement. Propensity score matching yielded 133 pairs of patients receiving hemiarch and non-hemiarch. RESULTS Sinus segment diameter was similar between groups; ascending aortic diameter was greater in the hemiarch group (median 50 vs 44 mm; P < .001). The hemiarch group had longer perfusion (median 186 vs 120.5 minutes; P < .001) and crossclamp times (median 140 vs 104 minutes; P < .001); median circulatory arrest was 13 minutes. There was no difference, hemiarch versus no hemiarch, in 30-day mortality (3.0% vs 1.5%; P = .41), stroke (2.3% vs 4.5%; P = .31), reoperation for bleeding (11% vs 10%; P = .84), or overall survival (5-year 88.0% [95% confidence interval, 81.9-94.0] vs 91.4% [95% confidence interval, 85.8-96.9], P = .24). CONCLUSIONS In this series, aortic root replacement ± hemiarch reconstruction had low mortality. Addition of hemiarch replacement extended perfusion times but not at the expense of safety. Hemiarch reconstruction should be performed when the aortic root aneurysm extends into the distal ascending aorta.
Collapse
Affiliation(s)
| | - Brett F Duncan
- Division of Cardiothoracic Surgery, Northwestern University, Chicago, Ill
| | - Chris K Mehta
- Division of Cardiothoracic Surgery, Northwestern University, Chicago, Ill
| | - Mitesh V Badiwala
- Division of Cardiothoracic Surgery, Northwestern University, Chicago, Ill
| | - Dan Rinewalt
- Division of Cardiothoracic Surgery, Northwestern University, Chicago, Ill
| | - Jane Kruse
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Ill
| | - Zhi Li
- Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Ill
| | | | - Patrick M McCarthy
- Division of Cardiothoracic Surgery, Northwestern University, Chicago, Ill
| |
Collapse
|
20
|
Vola M, Gerbay A, Campisi S, Duprey A, Heller F, Patoir A, Albertini JN, Fuzellier JF, Isaaz K, Favre JP. Endovascular repair of mitroaortic intervalvular fibrosa aneurysm after bentall surgery. Ann Thorac Surg 2015; 99:702-4. [PMID: 25639415 DOI: 10.1016/j.athoracsur.2014.04.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 02/16/2014] [Accepted: 04/04/2014] [Indexed: 11/15/2022]
Abstract
We report the first case of a successful transapical transcatheter treatment of a giant pseudoaneurysm originating from a rupture of the mitroaortic fibrosa that occurred 3 months after a Bentall procedure in a 81-year-old male patient. Because of the age of the patient and the location of the leak at the mitroaortic fibrosa, the risk of a conventional ascending aorta reoperation was considered too high, and a transcatheter approach was chosen. A transapical puncture was performed with a left minithoracotomy followed by a catheterization of the pseudoaneurysm neck and an 8-mm Amplatzer (St. Jude Medical, Saint Paul, MN, USA) device was delivered, resulting in a successful complete endovascular exclusion of the pseudo-aneurysmal sac.
Collapse
Affiliation(s)
- Marco Vola
- Cardiovascular Surgery Unit, University Hospital, Saint-Étienne, France.
| | - Antoine Gerbay
- Cardiology Unit, University Hospital, Saint-Étienne, France
| | - Salvatore Campisi
- Cardiovascular Surgery Unit, University Hospital, Saint-Étienne, France
| | - Ambroise Duprey
- Cardiovascular Surgery Unit, University Hospital, Saint-Étienne, France
| | - Fabien Heller
- Cardiovascular Surgery Unit, University Hospital, Saint-Étienne, France
| | - Arnaud Patoir
- Cardiovascular Surgery Unit, University Hospital, Saint-Étienne, France
| | | | | | - Karl Isaaz
- Cardiology Unit, University Hospital, Saint-Étienne, France
| | - Jean Pierre Favre
- Cardiovascular Surgery Unit, University Hospital, Saint-Étienne, France
| |
Collapse
|
21
|
Long-term results after proximal thoracic aortic redo surgery. PLoS One 2013; 8:e57713. [PMID: 23469220 PMCID: PMC3585872 DOI: 10.1371/journal.pone.0057713] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/25/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery. METHODS We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40) who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed. RESULTS In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64-0.93) as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06). Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79) but not advanced age (OR 2.46, 95%CI 0.48-12.66) as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months). One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%. CONCLUSIONS Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.
Collapse
|
22
|
Di Eusanio M, Savini C, Folesani G, Di Bartolomeo R. Improved brain and myocardial protection during complex aortic reinterventions. Ann Thorac Surg 2012; 95:358-9. [PMID: 23272866 DOI: 10.1016/j.athoracsur.2012.08.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/30/2012] [Accepted: 08/27/2012] [Indexed: 11/26/2022]
Abstract
In redo aortic surgery, an important issue of brain and myocardial protection is raised in patients presenting with large aneurysm (or pseudoaneurysm) adherent to the sternum and severe aortic valve regurgitation. We present our technique involving antegrade brain perfusion before resternotomy and left ventricle venting through the apex using a small anterolateral left thoracotomy.
Collapse
Affiliation(s)
- Marco Di Eusanio
- Department of Cardiac Surgery, S'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | | | | | | |
Collapse
|
23
|
Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [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: 11/26/2022]
|
24
|
Verbakel KMJ, van Straten AHM, Hamad MAS, Tan ESH, ter Woorst JF. Results of one-hundred and seventy patients after elective Bentall operation. Asian Cardiovasc Thorac Ann 2012; 20:418-25. [DOI: 10.1177/0218492312439057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the short and long-term operative results of patients who underwent a Bentall procedure in a 12-year period. We retrospectively analyzed the data of 170 patients who underwent an elective Bentall procedure between January 1998 and July 2010. All pre- and perioperative variable were entered into a multivariate regression model to identify significant predictors of early and late mortality. The early mortality rate was 11.2% (19/170 patients). Multivariate logistic regression analysis identified prior cardiac operation and cardiopulmonary bypass time as independent risk factors for early mortality, with odds ratios of 5.75 (95% confidence interval: 1.850–17.874; p = 0.003) and 1.011 (95% confidence interval: 1.003–1.019; p = 0.008), respectively. The Kaplan-Meier curve shows an overall survival of 78% ± 4% at 5 years and 66% ± 10% at 10 years. Cox regression analysis revealed no independent risk factors for late mortality. The Bentall procedure is still the procedure of choice for aortic root replacement. Improvements in perioperative management in recent years has improved the early outcome, and in our experience, the late results of this technique were satisfactory.
Collapse
Affiliation(s)
- Karin MJ Verbakel
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Albert HM van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Erwin SH Tan
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Joost F ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| |
Collapse
|
25
|
Wegdam-Blans MCA, ter Woorst JF, Klompenhouwer EG, Teijink JA. David procedure during a reoperation for ongoing chronic Q fever infection of an ascending aortic prosthesis. Eur J Cardiothorac Surg 2012; 42:e19-20. [DOI: 10.1093/ejcts/ezs217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|