1
|
Svensson LG, Vargo PR, Desai MY, Kalahasti V, Griffin B, Roselli EE, Rosinski BF, Rajeswaran J, Blackstone EH. Aortic valve reimplantation in patients with connective tissue disorders: Are the leaflets durable? J Thorac Cardiovasc Surg 2023; 166:1617-1626.e6. [PMID: 36740496 DOI: 10.1016/j.jtcvs.2022.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/27/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The durability of reimplanted myxomatous aortic valves in root replacements for patients with connective tissue disorders (CTD) is unclear; therefore, we sought to evaluate the long-term resilience of these repairs. METHODS From January 1980 to January 2020, 214 patients with CTD and 645 without CTD underwent primary, elective aortic valve reimplantation operations at Cleveland Clinic. The CTD cohort included 164 (77%) with Marfan, 23 (11%) with Loeys-Dietz, and 7 (3.3%) with Ehlers-Danlos CTD. We accounted for differing patient characteristics between the groups by propensity score matching to compare outcomes, yielding 96 matched pairs. Longitudinal echocardiographic measures were compared using nonlinear mixed effects models. RESULTS In the CTD cohort, there were no operative mortalities (30-day or in-hospital), 1 (0.47%) stroke, and 1 (0.47%) early in-hospital reoperation for valve dysfunction. Ten-year prevalence of no aortic regurgitation was 86%, mild 11%, and moderate 3%. Ten-year freedom from reoperation was 97%. In propensity matched cohorts, there were no significant differences in in-hospital outcomes, longitudinal aortic regurgitation and mean gradient, risk of reoperation on the aortic valve, or risk of late death. CONCLUSIONS Aortic valve reimplantation is a durable operation in patients with CTD and root aneurysms. These patients do not experience early degeneration of their reimplanted aortic valves.
Collapse
Affiliation(s)
- Lars G Svensson
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Patrick R Vargo
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vidyasagar Kalahasti
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brad F Rosinski
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
2
|
Shrestha M, Boethig D, Krüger H, Kaufeld T, Martens A, Haverich A, Beckmann E. Valve-sparing aortic root replacement using a straight tube graft (David I procedure). J Thorac Cardiovasc Surg 2023; 166:1387-1397.e10. [PMID: 35644632 DOI: 10.1016/j.jtcvs.2022.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We present our 25-year experience with valve-sparing aortic root replacement using a straight tube graft (David-I). METHODS From 1993 to 2019, 677 patients (median age, 56.0 years; range, 42-65) underwent the David-I procedure with a straight tube graft. A total of 24 different surgeons performed these operations. Marfan syndrome was present in 111 patients (16.4%), and bicuspid aortic valve was present in 71 patients (10.5%). Aortic root aneurysm was present in 544 patients (80.4%), and acute dissection was present in 133 patients (19.6%). RESULTS Ministernotomy was used in 57 patients (8.4%). Additional cusp plasty was performed in 84 patients (12.4%). Concomitant procedures were coronary artery bypass grafting (n = 122, 18.0%), mitral valve surgery (n = 34, 5%), proximal arch replacement (n = 125, 18.4%), subtotal arch replacement (n = 43, 6.4%), and total arch replacement (n = 102, 15.1%). Overall in-hospital mortality was 4.0% (n = 27), and perioperative stroke occurred in 26 patients (3.8%). Postoperative echocardiography showed aortic insufficiency less than I° in 600 of 623 (96.3%). The 1-, 5-, 10-, 15-, and 20-year survivals were 97%, 92%, 79%, 68%, and 50%, respectively. The rates for freedom from aortic valve-related reoperation at 1, 5, 10, 15, and 20 years were 97%, 92%, 87%, 84%, and 80%, respectively. Multivariate Cox regression analysis identified age (odds ratio, 0.974; 95% confidence interval, 0.957-0.992; P = .004), senior surgeon (odds ratio, 0.546; 95% confidence interval, 0.305-0.979; P = .042), and residual postoperative aortic insufficiency (odds ratio, 4.864; 95% confidence interval, 1.124-21.052; P = .034) as independent risk factors for aortic valve-related reoperation. CONCLUSIONS The aortic valve-sparing David-I procedure can be performed with very low perioperative morbidity and mortality. The short- and long-term results are excellent. The straight tube graft does not lead to increased leaflet erosion. This procedure is reproducible by multiple surgeons.
Collapse
Affiliation(s)
- Malakh Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Dietmar Boethig
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heike Krüger
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Erik Beckmann
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
3
|
Bani Hani A, Awamleh N, Mansour S, Toubasi AA, AlSmady M, Abbad M, Banifawaz M, Abu Abeeleh M. Valve Surgery in a Low-Volume Center in a Low- and Middle-Income Country: A Retrospective Cross-Sectional Study. Int J Gen Med 2023; 16:4649-4660. [PMID: 37868818 PMCID: PMC10589403 DOI: 10.2147/ijgm.s433722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
Background Valvular heart disease (VHD) has a significant prevalence and mortality rate with surgical intervention continuing to be a cornerstone of therapy. We aim to report the outcome of patients undergoing heart valve surgery (HVS) in a low-volume center (LVC) in a low- and middle-income country (LMIC). Methods A cross-sectional retrospective study was conducted at the Jordan University Hospital (JUH), a tertiary teaching hospital in a developing country, between April 2014 and December 2019. Patients who underwent mitral valve replacement (MVR), aortic valve replacement (AVR), tricuspid valve replacement (TVR), double valve replacement (DVR), CABG + MVR, and CABG + AVR patients were included. Thirty-day and two-year mortalities were taken as the primary and secondary outcomes, respectively. Results A total number of 122 patients were included, and the mean age was 54.46 ± 14.89 years. AVR was most common (42.6%). There was no significant association between STS mortality score or Euroscore II with 30-day and 2-year mortality. Conclusion LVC will continue to have a role in LMICs, especially during development to HICs. Further global studies are needed to assert the safety of HVS in LVC and LMICs.
Collapse
Affiliation(s)
- Amjad Bani Hani
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Nour Awamleh
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Shahd Mansour
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ahmad A Toubasi
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Moaath AlSmady
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Mutaz Abbad
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Banifawaz
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Mahmoud Abu Abeeleh
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| |
Collapse
|
4
|
Zuo Y, Tan R, Qin C. Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis. J Cardiothorac Surg 2023; 18:206. [PMID: 37400892 DOI: 10.1186/s13019-023-02329-8] [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: 11/22/2022] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). DESIGN Meta-analysis with meta-regression and systematic review. SETTING Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. INTERVENTIONS All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. RESULT Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. CONCLUSION The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.
Collapse
Affiliation(s)
- Yiding Zuo
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ruixi Tan
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chaoyi Qin
- Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, 610041, China.
| |
Collapse
|
5
|
Malaisrie SC, Kislitsina ON, Wilsbacher L, Mendelson M, Puthumana JJ, Vassallo P, Kruse J, Andrei AC, McCarthy PM. Valve-sparing versus valve-replacing aortic root replacement in patients with aortic root aneurysm. J Card Surg 2022; 37:1947-1956. [PMID: 35384050 DOI: 10.1111/jocs.16473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Valve-sparing aortic root replacement (VSARR) is an alternative to valve-replacing aortic root replacement (VRARR) with valved-conduits based on recent guidelines for clinical practice. This study investigated outcomes of these two procedures in patients with nonstenotic valves. METHODS Between January 7, 2007 and June 30, 2019, 475 patients with aortic root aneurysm without aortic stenosis underwent VSARR (151) or VRARR (324) techniques. Propensity score-matching (PSM) was used to alleviate confounding. Endpoints were 30-day mortality, 8-year survival and reoperation, aortic regurgitation, and valve gradients. RESULTS PSM created 69 pairs of patients with a mean age 52 ± 13 years (10.1% Marfan syndrome, 34.8% bicuspid aortic valve). There was no statistically significant difference in major perioperative morbidity or 30-day mortality (0% VSARR vs. 1.4% VRARR; p = 0.316). Overall survival was significantly higher (p = 0.025) in the VSARR group versus the VRARR group (8-year estimates 100% vs. 88.9%, respectively), while freedom from valve reoperation was similar (p = 0.97, 8-year estimates 90.9% vs. 96.7%, respectively). Freedom from > moderate-severe AR was not significantly different (p = 0.08, 8-year estimates 90.0% VSARR group vs. 100% VRARR), but mean valve gradients at last follow-up were better in the VSARR group (5.9 vs. 13.2 mmHg, p < 0.001). CONCLUSIONS VSARR is a safe operation in patients with aortic root aneurysm and nonstenotic aortic valves in the hands of experienced surgeons. Freedom from reoperation is similar and the mode of aortic valve failure differs between the two groups.
Collapse
Affiliation(s)
- S Chris Malaisrie
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Olga N Kislitsina
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa Wilsbacher
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Marla Mendelson
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jyothy J Puthumana
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Patricia Vassallo
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jane Kruse
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Adin-Cristian Andrei
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University, Chicago, Illinois, USA
| | - Patrick M McCarthy
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
6
|
Zhu Y, Jian Z, Ma R, Wang Y, Xiao Y. Long-term outcomes after aortic root replacement for patients with Marfan syndrome. J Thorac Dis 2022; 13:6779-6789. [PMID: 35070362 PMCID: PMC8743404 DOI: 10.21037/jtd-21-577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022]
Abstract
Background A diversity of surgical strategies are used to treat Marfan syndrome patients with aortic disease. We sought to evaluate the long-term efficiency of aortic root replacement (ARR) for patients with Marfan syndrome. Methods Data were collected from 131 patients with Marfan syndrome and aortic disease who underwent ARR in our center. We retrospectively analyzed the long-term outcomes of these patients, among whom 68 had been diagnosed with aortic aneurysm (AA) and had undergone ARR. The remaining 63 patients had aortic dissection (AD); of these, 35 underwent ARR for limited ascending AD, while the others underwent ARR and total arch replacement combined with frozen elephant trunk (FET). Risk factors for survival and reoperation were identified. Results The operative mortality rate was 4.58%. Age >40 years was the sole risk factor for operative mortality. During follow-up, 12 deaths occurred. Patients aged <25 years and female patients were more prone to late death than were other patients. Indications for reoperation were noted in 22 patients, and the risk factors were age <30 years and female sex. At 5 years, the survival rate was 92.96%, and the freedom from reoperation rate was 88.36%. At 10 years, the survival rate was 85.25%, and the freedom from reoperation rate was 71.75%. The survival and freedom from reoperation rates were significantly higher in patients with AD than in those with AA. Specifically, chronic AD was a greater risk factor for late survival than was acute AD in patients with Marfan syndrome. Conclusions For patients with Marfan syndrome and aortic disease, ARR can be safely performed and results in low operative mortality and favorable long-term survival. Young and female patients have a higher risk for late death and reoperation. To prevent AD, surgical intervention should be promptly implemented following the diagnosis of aortic sinus dilation.
Collapse
Affiliation(s)
- Yu Zhu
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Zhao Jian
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ruiyan Ma
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yong Wang
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yingbin Xiao
- Department of Cardiovascular Surgery, the Second Affiliated Hospital, Army Medical University, Chongqing, China
| |
Collapse
|
7
|
OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6553745. [DOI: 10.1093/icvts/ivac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
|
8
|
Cvitkovic T, Bobylev D, Horke A, Avsar M, Beerbaum P, Martens A, Böthig D, Petenà E, Gutberlet M, Beyer FH, Wacker F, Cebotari S, Haverich A, Vogel-Claussen J, Sarikouch S, Czerner C. OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1307-1315. [PMID: 35079774 PMCID: PMC9154340 DOI: 10.1093/ejcts/ezac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tomislav Cvitkovic
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Corresponding author. Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany. Tel: +49-511-532-9829; e-mail: (T. Cvitkovic)
| | - Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department for Pediatric Cardiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Böthig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elena Petenà
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frerk Hinnerk Beyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Czerner
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
9
|
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
|
10
|
Bobylev D, Avsar M, Sarikouch S, Cvitkovic T, Boethig D, Westhoff-Bleck M, Bertram H, Beerbaum P, Haverich A, Horke A. Valve-sparing aortic root replacement in adult patients with congenital heart disease. Interact Cardiovasc Thorac Surg 2021; 33:959-965. [PMID: 34279037 DOI: 10.1093/icvts/ivab189] [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: 03/31/2021] [Revised: 05/12/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Aortic root dilatation is frequently observed in patients with congenital heart defects (CHD), but has received little attention in terms of developing a best practice approach for treatment. In this study, we analysed our experience with aortic valve-sparing root replacement in patients following previous operations to repair CHD. METHODS In this study, we included 7 patients with a history of previous surgery for CHD who underwent aortic valve-sparing operations. The underlying initial defects were tetralogy of Fallot (n = 3), transposition of great arteries (n = 2), coarctation of the aorta (n = 1), and pulmonary atresia with ventricle septum defect (n = 1). The patients' age ranged from 20 to 40 years (mean age 31 ± 6 years). RESULTS David reimplantation was performed in 6 patients and a Yacoub remodelling procedure was performed in 1 patient. Four patients underwent simultaneous pulmonary valve replacement. The mean interval between the corrective procedure for CHD and the aortic valve-sparing surgery was 26 ± 3 years. There was no operative or late mortality. The patient with transposition of great arteries following an arterial switch operation was re-operated 25 months after the valve-sparing procedure due to severe aortic regurgitation. In all other patients, the aortic valve regurgitation was mild or negligible at the latest follow-up (mean 8.7 years, range 2.1-15.1 years). CONCLUSIONS Valve-sparing aortic root replacement resulted in good aortic valve function during the first decade of observation in 6 of 7 patients. This approach can offer a viable alternative to root replacement with mechanical or biological prostheses in selected patients following CHD repair.
Collapse
Affiliation(s)
- Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tomislav Cvitkovic
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Harald Bertram
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
11
|
Yiğit G, Özen A, Çetinkaya F, Ünal EU, İşcan HZ, Birincioğlu CL, Sarıtaş A. Early and Late-Term Follow-Up Results of Patients Diagnosed with Aortic Aneurysm or Aortic Dissection with Aortic Regurgitation Undergoing Aortic Valve Repair or Valve-Sparing Aortic Surgery. Braz J Cardiovasc Surg 2021; 36:192-200. [PMID: 33113319 PMCID: PMC8163274 DOI: 10.21470/1678-9741-2020-0133] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Valve-reimplantation and remodelling techniques used in aortic reconstruction provide successful early, mid, and long-term results. We present our early and late-term experience with 110 patients with aortic regurgitation (AR) who underwent aortic valve repair (AVr) or valve-sparing aortic root surgeries (VSARS) due to aortic dissection or aortic aneurysm. METHODS Nine hundred eighty-two patients who underwent aneurysm or dissection surgery and aortic valve surgery between April 1997 and January 2017 were analysed using the patient database. A total of 110 patients with AR who underwent AVr or VSARS due to aortic dissection or aortic aneurysm were included in the study. RESULTS In the postoperative period, a decrease was observed in AR compared to the preoperative period (P<0.001); there was an increase in postoperative ejection fraction (EF) compared to the preoperative values (P<0.005) and a significant decrease in postoperative left ventricle diameters compared to the preoperative values (P<0.001). Kaplan-Meier analysis revealed one, two, four, and five-year freedom from moderate-severe AR as 95%, 91%, 87%, and 70%, respectively. Freedom from reoperation in one, two, and five years were 97.9%, 93.6%, and 81%, respectively. Eight patients (7.4%) underwent AVr during follow-up. Out of the remaining 100 patients, 13 (12%) had minimum AR, 52 (48%) had 1st-2nd degree AR, and 35 (32%) had 2nd-3rd degree AR during follow-up. CONCLUSION For the purpose of maintaining the native valve tissue, preserving the EF and the left ventricular end-diastolic diameter, valve-sparing surgeries should be preferred for appropriate patients.
Collapse
Affiliation(s)
- Görkem Yiğit
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Anıl Özen
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ferit Çetinkaya
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ertekin Utku Ünal
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Hakki Zafer İşcan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | | | - Ahmet Sarıtaş
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
12
|
Ntinopoulos V, Papadopoulos N, Odavic D, Haeussler A, Loeblein H, Dzemali O. Aortic Root Replacement with Reimplantation of the Aortic Valve: A Low-Volume Center Experience. Thorac Cardiovasc Surg 2021; 70:297-305. [PMID: 33601468 DOI: 10.1055/s-0041-1723844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Most data after root replacement with reimplantation of the aortic valve originate from high-volume centers. This raises concerns about the generalizability of these data and the reproducibility of this complex procedure. Aim of this study is to assess the perioperative and midterm outcomes of this procedure in a low-volume center. METHODS We performed a retrospective analysis of the data of 72 patients, who underwent root replacement with reimplantation of the aortic valve in a single center between 2011 and 2020. Time to event analysis was performed with Kaplan-Meier curves. Longitudinal analysis of serial echocardiographic data was performed with a mixed-effects ordinal logistic regression model. RESULTS In-hospital mortality was 1.4%, with absence of any neurological events during the perioperative period. At midterm follow-up, two further patients died. Overall survival rates at 1 and 5 years were 98.5% (95% confidence interval [CI]: 97-100%) and 96.3% (95% CI: 93.8-98.8%), respectively. During follow-up, five patients (6.9%) required reoperation on the aortic valve. The incidence of moderate and severe aortic regurgitation at 5 years was 6.6% (95% CI: 2.4-13.6%) and 0.6% (95% CI: 0.1-3.2%), respectively. Mild aortic regurgitation at hospital discharge (p < 0.001) and cusp plication (p = 0.0121) were associated with a higher incidence of moderate or severe aortic regurgitation at follow-up. CONCLUSION Reimplantation of the aortic valve is safe and feasible even in a low-volume center. Mortality, freedom from reoperation, and incidence of moderate or severe aortic regurgitation at follow-up are comparable to those of high-volume centers.
Collapse
Affiliation(s)
| | | | - Dragan Odavic
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Helen Loeblein
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| |
Collapse
|
13
|
Zhang B, Xue Q, Tang Y, Yu S, Fan X, Xu Z, Han L. Efficacy of cardiovascular surgery for Marfan syndrome patients: a single-center 15-year follow-up study. J Thorac Dis 2020; 12:7106-7116. [PMID: 33447399 PMCID: PMC7797851 DOI: 10.21037/jtd-20-2109] [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] [Indexed: 11/06/2022]
Abstract
Background Most Marfan syndrome (MFS) patients have thoracic aortic diseases which is the major cause of death. The aim of the study is to analyze the impact of different surgical procedures on prognosis of MFS patients. Methods We retrospectively analyzed the results of hospitalization and long-term follow-up of MFS patients who underwent surgical intervention in our center. Results Of the 135 MFS patients, 11 died during hospitalization (8.1%). There were no statistical differences in in-hospital mortality between the proximal surgery group and the distal surgery group (P=0.11). Compared to patients who underwent proximal aortic surgery, patients who underwent arch and distal surgery were more likely to have postoperative respiratory dysfunction (P=0.008). The type of surgical procedure was not associated with the incidence of complications during hospitalization. Pre-surgical New York Heart Association (NYHA) Functional Classification IV (P=0.047), EF <50% (P=0.047), pre-surgical atrial fibrillation (P=0.042), and the injury of dissection propagating onto coronary arteries (P=0.02) were independent risk factors for post-surgical mortality. After 15 years of follow-up, there were no deaths in the David group, while the 15-year survival rate for patients in the Bentall group was 73%±13.5%, and 71%±13.9% for patients in the arch surgery group (P=0.42). The probability of patients in the David group not requiring re-surgery after 15 years was 58.9%±20%, while it was 58.7%±12.1% for patients in the Bentall group, 71.5%±10.5% for patients in the Bentall + Arch group, and 12.5%±11.7% for patients in the Arch + Stent group (P=0.007). Conclusions The David procedure was the most beneficial and had the highest long-term patient survival rates.
Collapse
Affiliation(s)
- Boyao Zhang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Qing Xue
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Yangfeng Tang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Shangyi Yu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xingli Fan
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| |
Collapse
|
14
|
Abstract
The natural history of aortic regurgitation is not as benign as once believed, even in asymptomatic patients with preserved left ventricular function. Aortic valve surgery can prolong survival in these patients. However, both mechanical and biological aortic valve replacement have major disadvantages, especially in young patients. Aortic valve-preserving surgery has attracted a great deal of attention because it has a significant survival benefit over replacement. Nonetheless, aortic valve-preserving surgery has not been widely adopted due to the complexity of the technique and assessment (i.e., long learning curve). With recent technical and theoretical advances, aortic valve-preserving surgery has increasingly been performed with better outcomes, and therefore earlier surgical intervention in cases of aortic regurgitation has been considered. Recent advances in aortic valve-preserving surgery include repair-oriented classification of the etiology of aortic regurgitation, objective assessment of the cusp configuration (i.e., effective height and geometric height), use of aortic annuloplasty, introduction of two reproducible valve-sparing root replacement procedures (i.e., aortic valve reimplantation and aortic root remodeling techniques), standardization of aortic valve-preserving surgery, and assessment of cusp configuration with aortoscopy. A number of prospective multicenter studies are currently underway and will clarify the role of aortic valve-preserving surgery in the treatment of aortic regurgitation in the near future.
Collapse
Affiliation(s)
- Takashi Kunihara
- Department of Cardiac Surgery, The 12839Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
15
|
Liebrich M, Charitos E, Stadler C, Roser D, Merk DR, Doll N, Hemmer W, Voth V. Additional cusp reconstruction does not compromise valve durability and mid-term survival after the David procedure: results from 449 patients. Eur J Cardiothorac Surg 2020; 58:1072-1079. [PMID: 32408342 DOI: 10.1093/ejcts/ezaa149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate whether additional cusp interventions and valve types affect aortic valve-related reoperation and mortality rates after the David procedure. METHODS Between 1997 and 2018, a total of 449 patients {372 males; mean age 54.2 [standard deviation (SD) 15.2] years, range: 12.7-79.9 years} underwent elective valve-sparing aortic root replacement (David procedure) for aortic regurgitation and were prospectively followed up clinically and echocardiographically. RESULTS The follow-up was 94% complete. Cumulative follow-up time was 2268 patient-years [mean follow-up time 5.1 (4.3 SD) years]. Thirty-day mortality was 2.2% (n = 10). Late (>30 days) survival did not differ from that of the age- and gender-matched general population. Freedom from reoperation in patients without additional cusp reconstruction was 94% [95% confidence interval (CI) 91-98] and 92% (95% CI 88-97) at 5 and 10 years, respectively, which was not significantly different (P = 1) for patients who did require additional cusp reconstruction 98% (95% CI 95-100) and 89% (95% CI 81-99). In patients with tricuspid aortic valves (n = 338), freedom from reoperation was 96% (95% CI 94-99) and 93% (95% CI 88-97) at 5 and 10 years, respectively. Patients with bicuspid aortic valves (n = 111) had a freedom from reoperation of 94% (95% CI 89-99) at 5 years and 88% (95% CI 79-98) at 10 years (P = 0.021 for the comparison to tricuspid aortic valve). Overall, 23 patients (5%; 1%/patient-year) required reoperation with a mean interval of 4.5 (4.8 SD) months. CONCLUSIONS The David procedure revealed low mid-term reoperation risk and excellent survival independent of adjunctive cusp interventions/valve morphology and is comparable with that of the age- and gender-matched general population.
Collapse
Affiliation(s)
- Markus Liebrich
- Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany
| | | | - Charlotte Stadler
- Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany
| | - Detlef Roser
- Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany
| | - Denis R Merk
- Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany
| | - Nicolas Doll
- Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany
| | - Wolfgang Hemmer
- Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany
| | - Vladimir Voth
- Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany
| |
Collapse
|
16
|
Tamer S, Mastrobuoni S, Momeni M, Aphram G, Navarra E, Poncelet A, Noirhomme P, Astarci P, El Khoury G, de Kerchove L. Long-term experience with valve-sparing root reimplantation surgery in tricuspid aortic valve. Indian J Thorac Cardiovasc Surg 2020; 36:71-80. [PMID: 33061187 DOI: 10.1007/s12055-019-00842-x] [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] [Received: 03/19/2019] [Revised: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 01/16/2023] Open
Abstract
Objective To analyze our long-term experience with valve-sparing reimplantation technique in treating aortic root aneurysm, aortic regurgitation, and aortic dissection in patients with tricuspid aortic valve. Methods Between March 1998 and October 2018, 303 consecutive patients underwent valve-sparing reimplantation in our institution. The mean age of this cohort was 52.9 ± 15 years. Time to event analysis was performed with the Kaplan-Meier method. Risk of death, reoperation, and aortic regurgitation (AR) recurrence were analyzed using the cox-regression method. Results In-hospital mortality was 1% (n = 3) of which two were admitted for acute aortic dissection. Median follow-up was 5.81 years ([IQR]: 2.8-10 years). Thirty-nine patients (14.4%) died during follow-up. At 5 and 10 years, overall survival was 92 ± 2%and 75 ± 4.9%, respectively. Seventeen patients required late aortic valve reoperation. Freedom from valve reoperation was 95 ± 2% and 90 ± 3%. Freedom from AR > 2+ and AR > 1+ at 10 years was 91 ± 4% and 71.5 ± 4.6%, respectively. Significant multivariate predictors of death included age, New York Heart Association dyspnea class (NYHA), type A acute dissection (TAAD), and preoperative left ventricular end-diastolic diameter (LVEDD). Significant multivariate predictors of AR recurrence included indication for surgery, previous cardiac surgery, and presence of preoperative AR. Freedom from events like major bleeding, thromboembolic events, and infective endocarditis at 10 years were 97%, 98%, and 96%, respectively. Conclusions Aortic valve-sparing with the reimplantation technique has been performed for over two decades in our institution, and the results in patients with tricuspid aortic valve (TAV) are excellent in terms of survival and freedom from valve-related adverse outcomes including valve reoperation. These results continue supporting the use of valve sparing root replacement using the reimplantation technique (VSRR) in patients with aortic aneurysm, irrespective of whether they have preoperative AR or not. VSRR is safe, durable, and reproducible, but further follow-up, well into the second decade is still necessary.
Collapse
Affiliation(s)
- Saadallah Tamer
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stefano Mastrobuoni
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mona Momeni
- Division of Anesthesiologyy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gaby Aphram
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emiliano Navarra
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alain Poncelet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Noirhomme
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Parla Astarci
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent de Kerchove
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
17
|
Martens A, Beckmann E, Kaufeld T, Fleissner F, Neuser J, Korte W, Merz C, Krueger H, Haverich A, Shrestha M. Valve-sparing aortic root replacement (David I procedure) in Marfan disease: single-centre 20-year experience in more than 100 patients†. Eur J Cardiothorac Surg 2020; 55:476-483. [PMID: 30169770 DOI: 10.1093/ejcts/ezy300] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Valve-sparing aortic root replacement (VSARR) is recommended for patients with aortic root dilatation and preserved aortic valve cusp morphology. The durability of VSARR in Marfan patients has been questioned. The aim of our study was to establish the long-term outcomes of VSARR in Marfan patients. METHODS Between 1993 and 2015, 582 patients underwent VSARR (David I reimplantation) at our institution. Of these patients, 104 had Marfan disease. Thirteen surgeons performed the procedures in this group. The mean follow-up time was 12 ± 5.4 years (1201 patient-years). RESULTS Early mortality was 0.96%, and long-term survival was 91% at 10 years and 76% at 20 years in Marfan patients. Marfan patients had a significantly better survival compared to non-Marfan patients (P < 0.0001). Freedom from aortic-valve reoperation was 86% at 10 years and 80% at 20 years in Marfan patients. The reoperation rate was similar in Marfan and non-Marfan patients (P = 0.60). Morphological perioperative features (untreated prolapse, commissural plasty, cusp plasty and graft size mismatch) predicted long-term mortality (P = 0.0054). Graft size mismatch and untreated prolapse predicted structural valve deterioration (both P < 0.0001). Long-term valve function in event-free survivors was excellent [mean gradient 4.2 (2.9-6.9), 98% aortic regurgitation ≤ mild]. There were no valve-related thromboembolic or bleeding events. The endocarditis rate was 0.96%. Only 17% of the patients were on oral anticoagulants during the follow-up. CONCLUSIONS VSARR using the David I reimplantation technique results in excellent long-term outcomes in Marfan patients. We present the longest follow-up period so far. The genetic disease does not affect long-term valve function. The durability of the repair is affected by morphological perioperative criteria depending on surgical expertise, and dedicated training is recommended.
Collapse
Affiliation(s)
- Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Erik Beckmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Fleissner
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Julia Neuser
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wilhelm Korte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Constanze Merz
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heike Krueger
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Until the year 2000, the publications concerning aortic valve sparing (AVS) did not exceed 20 articles; in the following years almost 300 publications have appeared. Over 35 years from the introduction of valve sparing techniques and 500 years after the death of Leonardo da Vinci, this review highlights the significant steps in modern imaging techniques and the excellent clinical results in the field of reconstructive aortic root surgery. RECENT FINDINGS AVS operations underwent significant modifications over the last few years making it reproducible with satisfactory outcomes. The extraordinary potential of imaging opens new boundless horizons in the perspective of an increasingly patient-tailored surgical planning. The basic surgical concepts include the preservation and resuspension of the aortic valve in a near-normal environment (with the creation of functionally suited neo-aortic sinuses) and the re-establishment of a normal relationship of the aortic root components. SUMMARY Today is possible to perform a reimplantation procedure with the creation of neo-sinuses or a remodeling procedure with the addition of annular support. Both procedures can now guarantee an anatomical root reconstruction and an increased long-term durability. AVS operations have become established alternatives to Bentall procedures for patients with aortic root pathology, especially in young patients.
Collapse
|
19
|
Shen J, Gan C, Rajaguru RDT, Yuan D, Xiao Z. Management of a giant aortic root aneurysm in a young patient with Marfan syndrome: a case report. J Cardiothorac Surg 2020; 15:264. [PMID: 32972445 PMCID: PMC7513492 DOI: 10.1186/s13019-020-01304-x] [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: 07/16/2020] [Accepted: 09/08/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Marfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age. Case The patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed 190.5 cm of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. Transthoracic echocardiography and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we performed Bentall procedure based on the results of multidisciplinary team discussion and intraoperative exploration. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later. Conclusion It is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient’s specific situation should be taken into consideration. A mechanical Bentall procedure seems to be an acceptable option for some selected cases.
Collapse
Affiliation(s)
- Jiayu Shen
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Changping Gan
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - R D T Rajaguru
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Dou Yuan
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
20
|
De Paulis R, Scaffa R, Weltert L, Salica A. Mimicking mother nature: The Valsalva graft. J Thorac Cardiovasc Surg 2020; 159:1758-1763. [DOI: 10.1016/j.jtcvs.2019.06.128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 11/16/2022]
|
21
|
Long-term outcomes after valve-sparing anatomical aortic root reconstruction in acute dissection involving the root. J Thorac Cardiovasc Surg 2020; 159:1176-1184.e1. [DOI: 10.1016/j.jtcvs.2019.04.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/21/2019] [Accepted: 04/12/2019] [Indexed: 11/22/2022]
|
22
|
Li N, Zhang Y, Gao Y, Bai Y, An Z, Zhang G, Han Q, Lu F, Li B, Han L, Xu Z. Decision-making at initial surgery for type A aortic dissection in patients with Marfan syndrome: proximal or extensive repair. J Thorac Dis 2020; 11:4951-4959. [PMID: 32030210 DOI: 10.21037/jtd.2019.12.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Data on outcome of Stanford type A aortic dissection (TAAD) in Marfan syndrome (MFS) patients are limited. We investigated the full spectrum of reoperation and survival after initial surgery in MFS patients who suffered TAAD. Methods Retrospective analysis of 85 consecutive MFS patients in one-single center during the past 15 years. Results Overall, 85 MFS patients with TAAD underwent surgical repair [74% acute dissections; 80% DeBakey type I; 91% composite valved graft; 70% total arch replacement (TAR); 68% frozen elephant trunk (FET); 7% in-hospital mortality] at Changhai hospital affiliated to the Second Military Medical University over the past 15 years. Five (20.8%) patients in non-TAR group need aortic arch reintervention with resternotomy during follow-up, which is significantly higher than that in TAR group (P=0.001). Freedom from aortic arch reoperation in non-TAR group was all 78.7%±8.5% at 5, 10, and 15 years. No patient required aortic arch reoperation in TAR group (P=0.001). On the other hand, the FET was inserted into false lumen intentionally at initial surgery in 2 cases of chronic TAAD with narrowed true lumen. Scheduled thoracoabdominal aortic replacement was performed 6 months later. Both 2 patients are with well clinical outcomes. At last, we found that Debakey type and TAR at initial surgery were irrelevant to survival and reoperation for descending aorta. Conclusions TAR combined with FET is recommended in MFS patients when the aortic arch is dissected or enlarged. The FET could be inserted into the false lumen intentionally in selective case for scheduled 2-staged descending aortic repair.
Collapse
Affiliation(s)
- Ning Li
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yu Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yuan Gao
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yifan Bai
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhao An
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Guanxin Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Qingqi Han
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Fanglin Lu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - BaiLing Li
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Lin Han
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiyun Xu
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| |
Collapse
|
23
|
Moreau de Bellaing A, Pontailler M, Bajolle F, Gaudin R, Murtuza B, Haydar A, Vouhé P, Bonnet D, Raisky O. Ascending aorta and aortic root replacement (with or without valve sparing) in early childhood: surgical strategies and long-term outcomes. Eur J Cardiothorac Surg 2020; 57:373-379. [PMID: 31369065 DOI: 10.1093/ejcts/ezz210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Aortic root and ascending aorta replacements (AARs) are rarely required in the paediatric population. We report here a series of AAR performed in young children using different surgical techniques. METHODS Between 1995 and 2017, 32 children under the age of 10 years (median age 5.4 years) underwent AAR procedures at our institution. Twenty-two (69%) had a connective tissue disease (infantile Marfan syndrome or Loeys-Dietz syndrome). We performed 11 AAR using a composite graft with a mechanical prosthesis and 21 valve-sparing procedures (10 Yacoub operations and 11 David operations). Median follow-up for operative survivors was 7.7 years (interquartile range 4.2-12.8 years). RESULTS The cardiac-related early mortality rate was 6%. Patient survival was 91% at both 1 and 10 years. Eleven survivors (38%), all with a status of post-valve-sparing procedure, required an aortic root reintervention with an aortic valve replacement after a median interval of 4.2 years. Interestingly, only patients with infantile Marfan syndrome tended to be associated with risk of reoperation. CONCLUSIONS Aortic root and AARs are safe in young children whatever the surgical procedure. Aortic valve-sparing procedures show good long-term results except in children with infantile Marfan syndrome whose ineluctable aortic annulus dilatation or aortic valve regurgitation requires reintervention after a short period.
Collapse
Affiliation(s)
- Anne Moreau de Bellaing
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Margaux Pontailler
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Fanny Bajolle
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Régis Gaudin
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Bari Murtuza
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Ayman Haydar
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Pascal Vouhé
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Damien Bonnet
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiology, M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
24
|
Karciauskas D, Mizariene V, Jakuska P, Ereminiene E, Vaskelyte JJ, Nedzelskiene I, Kinduris S, Benetis R. Long-term outcomes and predictors of recurrent aortic regurgitation after aortic valve-sparing and reconstructive cusp surgery: a single centre experience. J Cardiothorac Surg 2019; 14:194. [PMID: 31718703 PMCID: PMC6852722 DOI: 10.1186/s13019-019-1019-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background Aortic valve sparing surgery (AVS), in combination with aortic cusp repair (ACR), still raises many questions about the increased surgical complexity and applicability for patients with pure aortic valve regurgitation (AR). The aim of this study was to investigate our long-term outcomes and predictors of recurrent AR (> 2+) after AVS and reconstructive cusp surgery. Methods We reviewed data of 81 patients who underwent AVS (a reimplantation technique) with concomitant ACR for AR and or dilatation of the aortic root at our institution during the period from April 2004 to October 2016. On preoperative echocardiography, the majority of the patients, 70 (86.4%) presented with severe AR grade (> 3+) and 28 (34.5%) of the patients had the bicuspid phenotype. Time to event analysis (long-term survival, freedom from reoperation, and recurrence of AR > 2+) was performed with the Kaplan–Meier method. Multivariate Cox regression risk analysis was performed to identify independent predictors of recurrent AR (> 2+). The mean follow-up was 5.3 ± 3.3 years and 100% complete. Results The in-hospital (30-day) mortality rate after elective surgery was 1.2%. The overall actuarial survival rates were 92.9 ± 3.1% and 90.4 ± 3.9% at five and 10 years, respectively. Actuarial freedom from recurrent AR (> 2+) was 83.7 ± 4.5% within the cohort at five and 10 years. The cumulative freedom from all causes of cardiac reoperation was 94.2 ± 2.8% within the cohort at 10 years. Neither bleeding nor thromboembolic or permanent neurologic events were reported during follow-up. By multivariate analysis, independent predictors of reccurent AR (> 2+) were an effective height lower than 9 mm (p= 0.02) and intraoperative residual mild AR (p= 0.0001). Conclusions AVS with ACR, combined in a systematic fashion, is a safe and reproducible option with low risk of long-term valve related events and normal life expectancy for patients with pure aortic regurgitation. The competent aortic valve and effective height, not lower than 9 mm intraoperatively, are mandatory to achieve long-lasting AV competency.
Collapse
Affiliation(s)
- Dainius Karciauskas
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307, Kaunas, LT, Lithuania.
| | - Vaida Mizariene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuska
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307, Kaunas, LT, Lithuania
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jolanta Justina Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irena Nedzelskiene
- Department of Dental and Oral Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sarunas Kinduris
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307, Kaunas, LT, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, 44307, Kaunas, LT, Lithuania
| |
Collapse
|
25
|
Leidenberger T, Gordon Y, Farag M, Delles M, Fava Sanches A, Fink MA, Kallenbach K, Kauczor HU, Rengier F. Imaging-Based 4D Aortic Pressure Mapping in Marfan Syndrome Patients: A Matched Case-Control Study. Ann Thorac Surg 2019; 109:1434-1440. [PMID: 31568745 DOI: 10.1016/j.athoracsur.2019.08.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/22/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Marfan syndrome predisposes to aortic aneurysm, dissection, and rupture. We sought to investigate aortic 4-dimensional (4D) relative pressure maps derived from 4D flow cardiovascular magnetic resonance to identify disease characteristic alterations of the intraaortic pressure field in Marfan patients with aortic root dilation compared with age- and sex-matched healthy controls. METHODS This prospective case-control study included 11 Marfan patients with aortic root dilation (31 ± 5 years, 5 female) and 11 age- and sex-matched healthy controls (31 ± 8 years, 5 female) undergoing 4D flow cardiovascular magnetic resonance of the thoracic aorta. 4D relative pressure maps were computed and compared between groups for 8 aortic regions. RESULTS Aortic root diameters were significantly larger in patients compared with controls (43 vs 31 mm, P < .001), but not in the proximal descending aorta (23 vs 21 mm, P = .19). Regional pressure gradients over the cardiac cycle were significantly altered in Marfan patients with significantly higher minimum pressure gradients in the proximal ascending aorta (-44.3 vs -97.0 mm Hg/m, P < .001) and significantly lower maximum pressure gradients in the proximal descending aorta (55.1 vs 82.3 mm Hg/m, P < .01). The latter finding was associated with pathologic vortical flow patterns. Regional pressure gradient at mid systole significantly correlated with aortic diameter (proximal ascending aorta: r = 0.73, P < .001; proximal descending aorta: r = -0.59, P = .004). CONCLUSIONS Noninvasive 4D pressure mapping derived from 4D flow cardiovascular magnetic resonance revealed significant alterations of spatiotemporal pressure characteristics in the thoracic aorta of Marfan patients. These alterations were most pronounced in the proximal ascending aorta and the proximal descending aorta, corresponding to the regions where aortic dissections often originate in Marfan patients.
Collapse
Affiliation(s)
- Tilman Leidenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Yaron Gordon
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Delles
- Department of Informatics, Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Augusto Fava Sanches
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias A Fink
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kallenbach
- Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany; Department of Cardiac Surgery, INCCI HaerzZenter, Luxembourg, Luxembourg
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), University of Heidelberg, Heidelberg, Germany
| | - Fabian Rengier
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Interdisciplinary Marfan Centre, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC), University of Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
| |
Collapse
|
26
|
Ueno G, Ohno N. Aortic valve approaches in the era of minimally invasive cardiac surgery. Surg Today 2019; 50:815-820. [PMID: 31342159 DOI: 10.1007/s00595-019-01848-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/21/2019] [Indexed: 12/23/2022]
Abstract
The concept of minimally invasive cardiac surgery has been gradually adopted world-wide since its inception more than 2 decades ago. Recently, catheter intervention has been used in the treatment of structural heart disease. Most notably, minimally invasive transcatheter aortic valve implantation is now an established treatment option for aortic valve stenosis. There are three major approaches for minimally invasive aortic valve surgery: via median sternotomy, via the parasternal approach, and via the thoracotomy approach. All these approaches allow for a small skin incision and/or avoid full sternotomy. Moreover, several advanced variations with additional aortic procedures or totally endoscopic management have been developed. When considering each approach, low invasiveness must be balanced with safety, as surgeons broaden their insight of advanced medicine. Physical invasiveness is largely related to the surgical approach in minimally invasive surgery. We review the history and evolution of the different surgical approaches for minimally invasive aortic valve replacement.
Collapse
Affiliation(s)
- Go Ueno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan.
| |
Collapse
|
27
|
Karciauskas D, Mizariene V, Jakuska P, Ereminiene E, Orda P, Ordiene R, Vaskelyte JJ, Nedzelskiene I, Kinduris S, Benetis R. Early and long-term results of aortic valve sparing aortic root reimplantation surgery for bicuspid and tricuspid aortic valves. Perfusion 2019; 34:482-489. [DOI: 10.1177/0267659119831926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: To evaluate early and long-term clinical outcomes following aortic valve sparing aortic root reimplantation surgery in patients with leaking bicuspid and tricuspid aortic valves. Methods: The study consisted of 92 consecutive adult patients (tricuspid aortic valve group = 63 and bicuspid aortic valve group = 29) who underwent aortic valve sparing aortic root reimplantation surgery with or without aortic cusp repair for dilatation of the aortic root and/or aortic valve regurgitation at our institution from April 2004 to October 2016. Clinical outcomes were investigated using Kaplan–Meier and log-rank tests between groups. Results: The follow-up was 100% complete with a mean time of 5.3 ± 3.3 years. The 30-day in-hospital mortality was 3.1% in tricuspid aortic valve group and 3.4% in bicuspid aortic valve group patients. The overall survival rates at 10 years did not differ between bicuspid aortic valve and tricuspid aortic valve patient groups (96.6 ± 3.3% vs. 90.3 ± 4.2%, p = 0.3). Freedom from recurrent aortic valve regurgitation (>2+) at 10 years was 90.5 ± 4.1% in tricuspid aortic valve group and 75.7 ± 8.7% in bicuspid aortic valve group (p = 0.06). Freedom from aortic valve reoperation at 10 years was 100% in tricuspid aortic valve group and 83.9 ± 7.4% in bicuspid aortic valve group (p = 0.002). Conclusion: Aortic valve sparing aortic root reimplantation surgery is a safe and efficient technique, providing acceptable long-term survival with low rates of valve-related complications in both tricuspid aortic valve and bicuspid aortic valve patient groups. However, aortic valve reoperation rates at 10 years follow-up were higher in bicuspid aortic valve group patients compared to tricuspid aortic valve group patients.
Collapse
Affiliation(s)
- Dainius Karciauskas
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vaida Mizariene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuska
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Orda
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rasa Ordiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jolanta Justina Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irena Nedzelskiene
- Department of Dental and Oral Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sarunas Kinduris
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Clark JB. Continued pursuit of evidence-based indications and the optimal operation for pediatric valve-sparing aortic root replacement. J Thorac Cardiovasc Surg 2018; 157:1112-1113. [PMID: 30414777 DOI: 10.1016/j.jtcvs.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Joseph B Clark
- Division of Pediatric Cardiac Surgery, Department of Pediatrics, Penn State Children's Hospital, Hershey, Pa.
| |
Collapse
|