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Frankel WC, Robinson JA, Roselli EE, Unai S, Tretter JT, Fuller S, Nelson JS, Ghobrial J, Svensson LG, Pettersson GB, Najm HK, Karamlou T. Lifetime Management of Adolescents and Young Adults with Congenital Aortic Valve Disease. Ann Thorac Surg 2024:S0003-4975(24)00461-2. [PMID: 38871162 DOI: 10.1016/j.athoracsur.2024.04.038] [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: 11/15/2023] [Revised: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 06/15/2024]
Abstract
In this invited expert review, we focus on evolving lifetime management strategies for adolescents and young adults with congenital aortic valve disease, acknowledging that these patients often require multiple interventions during their lifetime. Our goal is to preserve the native aortic valve when feasible. Leveraging advanced multimodality imaging, a detailed assessment of the aortic valve and root complex can be obtained, and a surgically approach tailored to an individual patient's anatomy and pathology can be used. In turn, aortic valve repair and reconstruction can be offered to a greater number of patients, either as a definitive strategy or as a component of a staged strategy to delay the need for aortic valve replacement until later in life when more options are available.
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Affiliation(s)
- William C Frankel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin A Robinson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin T Tretter
- Department of Pediatric Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer S Nelson
- Division of Cardiovascular Surgery, Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, Florida
| | - Joanna Ghobrial
- Department of Pediatric Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hani K Najm
- Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
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Galzerano D, Kholaif N, Al Amro B, Al Admawi M, Eltayeb A, Alshammari A, Di Salvo G, Al-Halees ZY. The Ross Procedure: Imaging, Outcomes and Future Directions in Aortic Valve Replacement. J Clin Med 2024; 13:630. [PMID: 38276135 PMCID: PMC10816914 DOI: 10.3390/jcm13020630] [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: 11/02/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024] Open
Abstract
The Ross procedure is gaining recognition as a significant option for aortic valve replacement (AVR), and is particularly beneficial in specific patient groups. Although categorized as a class IIb recommendation in the 2020 American College of Cardiology (ACC)/American Heart Association (AHA), and the European Society of Cardiology (ESC) management guidelines on valvular heart disease, recent studies bolster its credibility. Research, including a propensity-matched study, underlines the Ross procedure's association with enhanced long-term survival and reduced adverse valve-related events compared to other AVR types. This positions the Ross procedure as a primary option for AVR in young and middle-aged adults within specialized centers, and potentially the only choice for children and infants requiring AVR. This review meticulously examines the Ross procedure, covering historical perspectives, surgical techniques, imaging, and outcomes, including hemodynamic performance and quality of life, especially focusing on pediatric and young adult patients. It explores contemporary techniques and innovations like minimally invasive approaches and tissue engineering, underscoring ongoing research and future directions. A summarization of comparative studies and meta-analyses reiterates the Ross procedure's superior long-term outcomes, valve durability, and preservation of the left ventricular function, accentuating the crucial role of patient selection and risk stratification, and pinpointing areas for future research.
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Affiliation(s)
- Domenico Galzerano
- Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia; (D.G.); (B.A.A.); (M.A.A.); (A.E.); (A.A.); (Z.Y.A.-H.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Naji Kholaif
- Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia; (D.G.); (B.A.A.); (M.A.A.); (A.E.); (A.A.); (Z.Y.A.-H.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Bandar Al Amro
- Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia; (D.G.); (B.A.A.); (M.A.A.); (A.E.); (A.A.); (Z.Y.A.-H.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Mohammed Al Admawi
- Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia; (D.G.); (B.A.A.); (M.A.A.); (A.E.); (A.A.); (Z.Y.A.-H.)
| | - Abdalla Eltayeb
- Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia; (D.G.); (B.A.A.); (M.A.A.); (A.E.); (A.A.); (Z.Y.A.-H.)
| | - Amal Alshammari
- Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia; (D.G.); (B.A.A.); (M.A.A.); (A.E.); (A.A.); (Z.Y.A.-H.)
| | - Giovanni Di Salvo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Medical School, University of Padua, 35122 Padua, Italy;
| | - Zohair Y. Al-Halees
- Heart Center Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia; (D.G.); (B.A.A.); (M.A.A.); (A.E.); (A.A.); (Z.Y.A.-H.)
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Bilodeau KS, Mauchley DC, DeRoo S, Burke CR. Dissemination and implementation analysis of the Ross procedure in adults: time to update the guidelines? THE CARDIOTHORACIC SURGEON 2023; 31:28. [PMID: 38152292 PMCID: PMC10752239 DOI: 10.1186/s43057-023-00119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/09/2023] [Indexed: 12/29/2023] Open
Abstract
Background The science of dissemination and implementation (D&I) aims to improve the quality and effectiveness of care by addressing the challenges of incorporating research and evidence-based practice into routine clinical practice. This lens of D&I has challenged the interpretation and incorporation of data, noting that failure of a given therapy may not reflect lack of efficacy, but instead reflect an imperfect implementation. The aim of this manuscript is to review the influence of the Ross procedure's historical context on its D&I. Methods A contextual baseline of the Ross procedure was defined from the procedure's original description in the literature to major publications since the 2017 valvular heart disease guidelines. D&I evaluation was conducted using the Consolidated Framework for Implementation Research (CFIR), using constructs from each of the five respective domains to define the main determinants. Results Each of the five CFIR domains appears to be correlated with a factor influencing the Ross procedure's varied history of enthusiasm and acceptance. The complex nature of Ross required adaptation for optimization, with a strong correlation of center volume on outcomes that were not considered in non-contemporary studies. Outcomes later published from those studies influenced social and cultural contexts within the aortic surgery community, and led to further organizational uncertainty, resulting in slow guideline incorporation. Conclusions The D&I of the Ross procedure was a result of inadequate appreciation of technical complexity, effect of patient selection, and complex aortic surgery experience, resulting in dismissal of an efficacious procedure due to a misunderstanding of effectiveness.
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Affiliation(s)
- Kyle S. Bilodeau
- Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, WA USA
| | - David C. Mauchley
- Department of Surgery, Division of Cardiac Surgery, Seattle Children’s Hospital, Seattle, WA USA
| | - Scott DeRoo
- Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, WA USA
| | - Christopher R. Burke
- Department of Surgery, Division of Cardiothoracic Surgery, University of Washington, Seattle, WA USA
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Shih E, Ryan WH, Squiers JJ, Schaffer JM, Harrington KB, Banwait JK, Meidan TG, DiMaio JM, Brinkman WT. Outcomes of the Ross procedure in patients older versus younger than 50 years old. Eur J Cardiothorac Surg 2023; 64:ezad260. [PMID: 37439708 DOI: 10.1093/ejcts/ezad260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The Ross procedure is traditionally considered for young adult patients with aortic valve disease. This study compares long-term outcomes of patients undergoing the Ross procedure who are ≥50 and <50-years old. METHODS Data were collected from 225 patients undergoing Ross procedure at a single centre from 1994 to 2019. Patients were categorized into younger (<50-years old; n = 156) and older (≥50-years old; n = 69) cohorts. Baseline demographics clinical outcomes were compared. RESULTS The mean age was 36 ± 8.1 and 55 ± 4.2 years in the younger and older cohort, respectively. Both groups were predominantly male (58.5% vs 69.6%; P = 0.59). The younger group had a higher rate of aortic insufficiency (51% vs 26.1%; P < 0.01), and bicuspid aortic valve (81.4% vs 58.0%; P < 0.01). Aortic stenosis was more prevalent in the older cohort (25.6% vs 58.0%; P < 0.01). Operative mortality was acceptable in both groups (1.3% vs 4.3%; P = 0.15). Survival up to 10 years was not statistically different between 2 groups (96.2% vs 91.3% P = 0.16), whereas survival up to 15 years for younger patients was significantly higher (94.9% vs 85.5%; P = 0.03). After non-cardiac related deaths were excluded, survival up to 15 years (98.7% vs 91.3%; P = 0.02) was significantly lower than younger patients. In both groups, survival after the Ross procedure was similar to the age- and sex-matched US population. CONCLUSIONS Survival up to 10 years after Ross procedure were similar, but up to 15 years was significantly higher in younger patients. The Ross procedure restored patients from both groups to expected survival. Our results suggest that at experienced centres, the Ross procedure is a safe and reasonable option for patients who are 50 years and older.
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Affiliation(s)
- Emily Shih
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital-Plano, Plano, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - William H Ryan
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital-Plano, Plano, TX, USA
| | - John J Squiers
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital-Plano, Plano, TX, USA
| | - Justin M Schaffer
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital-Plano, Plano, TX, USA
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital-Plano, Plano, TX, USA
| | | | - Talia G Meidan
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - J Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital-Plano, Plano, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - William T Brinkman
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital-Plano, Plano, TX, USA
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Galzerano D, Pergola V, Eltayeb A, Ludovica F, Arbili L, Tashkandi L, Michele SD, Barchitta A, Parato MV, Salvo GD. Echocardiography in Simple Congenital Heart Diseases: Guiding Adult Patient Management. J Cardiovasc Echogr 2023; 33:171-182. [PMID: 38486692 PMCID: PMC10936704 DOI: 10.4103/jcecho.jcecho_52_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/10/2023] [Indexed: 03/17/2024] Open
Abstract
This article provides comprehensive insights into the evaluation of simple congenital heart diseases (CHDs) in adults, emphasizing the pivotal role of echocardiography. By focusing on conditions such as congenital aortic stenosis, aortic coarctation, patent ductus arteriosus, atrial septal defects (ASDs), and ventricular septal defects (VSDs), the review underscores echocardiography's intricate contributions to precise clinical decision-making. Echocardiography serves as the primary imaging modality, offering high-resolution visualization of anatomical anomalies and quantification of hemodynamic parameters. It enables tailored therapeutic strategies through its capacity to discern the dimensions, spatial orientation, and dynamic shunt dynamics of defects such as ASDs and VSDs. Moreover, echocardiography's advanced techniques, such as tissue Doppler imaging and speckle tracking, provide detailed insights into atrial mechanics, diastolic function, and ventricular filling kinetics. Integration of echocardiographic findings into clinical practice empowers clinicians to create personalized interventions based on quantified ventricular function, which spans systolic and diastolic aspects. This approach facilitates risk stratification and therapeutic planning, particularly pertinent in heart failure management within the CHD patient population. In summary, echocardiography transcends its role as an imaging tool, emerging as a precision-guided instrument adept at navigating the complexities of simple CHD in adults. Its ability to expedite diagnosis, quantify hemodynamic impacts, and unravel multifaceted functional dynamics culminates in a comprehensive depiction of these conditions. The fusion of these insights with clinical expertise empowers clinicians to navigate the intricate pathways of CHD, crafting tailored therapeutic strategies characterized by precision and efficacy.
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Affiliation(s)
- Domenico Galzerano
- The Heart Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | - Abdalla Eltayeb
- The Heart Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fulgione Ludovica
- Department of Diagnostic Radiological Imaging, Maddaloni Hospital, Maddaloni (CE), Roma, Italy
| | - Lana Arbili
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Loay Tashkandi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Maurizio Vito Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
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6
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Di Salvo G, Cattapan I, Fumanelli J, Pozza A, Moscatelli S, Sabatino J, Avesani M, Reffo E, Sirico D, Castaldi B, Cerutti A, Biffanti R, Pergola V. Childhood Obesity and Congenital Heart Disease: A Lifelong Struggle. J Clin Med 2023; 12:6249. [PMID: 37834891 PMCID: PMC10573337 DOI: 10.3390/jcm12196249] [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: 07/31/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Congenital heart disease (CHD) affects approximately one in every one hundred infants worldwide, making it one of the most prevalent birth abnormalities globally. Despite advances in medical technology and treatment choices, CHD remains a significant health issue and necessitates specialized care throughout an individual's life. Childhood obesity has emerged as a novel global epidemic, becoming a major public health issue, particularly in individuals with lifelong conditions such as CHD. Obesity has profound effects on cardiac hemodynamics and morphology, emphasizing the importance of addressing obesity as a significant risk factor for cardiovascular health. Obesity-induced alterations in cardiac function can have significant implications for cardiovascular health and may contribute to the increased risk of heart-related complications in obese individuals. Moreover, while diastolic dysfunction may be less apparent in obese children compared to adults, certain parameters do indicate changes in early left ventricular relaxation, suggesting that obesity can cause cardiac dysfunction even in pediatric populations. As most children with CHD now survive into adulthood, there is also concern about environmental and behavioral health risk factors in this particular patient group. Addressing obesity in individuals with CHD is essential to optimize their cardiovascular health and overall quality of life. This review aims to succinctly present the data on the impact of obesity on CHD and to enhance awareness of this perilous association among patients, families, and healthcare providers.
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Affiliation(s)
- Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Irene Cattapan
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Jennifer Fumanelli
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Alice Pozza
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Sara Moscatelli
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Jolanda Sabatino
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Martina Avesani
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
- Working Group on Congenital Heart Disease and Cardiovascular Prevention in Children, Italian Society of Cardiology (SIC), 00198 Rome, Italy;
| | - Elena Reffo
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Domenico Sirico
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Biagio Castaldi
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Alessia Cerutti
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Roberta Biffanti
- Paediatric Cardiology and Congenital Heart Disease Complex Unit, Department of Women’s and Child’s Health, University of Padua, 35122 Padua, Italy; (I.C.); (J.F.); (A.P.); (J.S.); (M.A.); (E.R.); (D.S.); (B.C.); (A.C.); (R.B.)
| | - Valeria Pergola
- Cardiology Unit, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy;
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Pergola V, Avesani M, Reffo E, Da Pozzo S, Cavaliere A, Padalino M, Vida V, Motta R, Di Salvo G. Unveiling the gothic aortic arch and cardiac mechanics: insights from young patients after arterial switch operation for d-transposition of the great arteries. Monaldi Arch Chest Dis 2023; 94. [PMID: 37768214 DOI: 10.4081/monaldi.2023.2712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The arterial switch operation (ASO) has become the standard surgical treatment for patients with d-transposition of the great arteries. While ASO has significantly improved survival rates, a subset of patients develop a unique anatomical anomaly known as the gothic aortic arch (GAA). Understanding cardiac mechanics in this population is crucial, as altered mechanics can have profound consequences for cardiac function and exercise capacity. The GAA has been associated with changes in ventricular function, hemodynamics, and exercise capacity. Studies have shown a correlation between the GAA and decreased ascending aorta distensibility, loss of systolic wave amplitude across the aortic arch, and adverse cardiovascular outcomes. Various imaging techniques, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, play a crucial role in assessing cardiac mechanics and evaluating the GAA anomaly. Despite significant advancements, gaps in knowledge regarding the prognostic implications and underlying mechanisms of the GAA anomaly remain. This review aims to explore the implications of the GAA anomaly on cardiac mechanics and its impact on clinical outcomes in young patients after ASO. Advancements in imaging techniques, such as computational modeling, offer promising avenues to enhance our understanding of cardiac mechanics and improve clinical management.
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Affiliation(s)
- Valeria Pergola
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Martina Avesani
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | - Elena Reffo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
| | | | | | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua.
| | - Raffaella Motta
- Radiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua.
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padua, University of Padua.
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8
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Di Michele S, Parato VM, Di Giannuario G, Kholaif N, Al Admawi M, Aljheish S, Arbili L, Alshammari A, Parato AG, Al Sergani H. Unlocking insights in bicuspid aortic valve management in adult patients: the vital role of cardiac imaging. Monaldi Arch Chest Dis 2023; 94. [PMID: 37721026 DOI: 10.4081/monaldi.2023.2761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023] Open
Abstract
The bicuspid aortic valve (BAV) presents a multifaceted clinical challenge due to its diverse morphologies and associated complications. This review aims to elucidate the critical role of cardiac imaging in guiding optimal management strategies for BAV patients. BAV, with a prevalence of 1-2%, has genetic underpinnings linked to the NOTCH1 gene mutation. Variability in BAV morphology necessitates tailored surgical approaches. The three primary types of BAV morphology - right-left cusp fusion, right-noncoronary cusp fusion, and left-noncoronary cusp fusion - demand nuanced considerations due to their distinct implications. Valvular dysfunction results in aortic stenosis or regurgitation, attributed to altered valve structure and turbulent hemodynamics. Cardiac imaging modalities, including echocardiography, magnetic resonance imaging, and computerized tomography, are instrumental in assessing valve function, aortic dimensions, and associated complications. Imaging helps predict potential complications, enabling informed treatment decisions. Regular follow-up is crucial to detecting alterations early and intervening promptly. Surgical management options encompass aortic valve repair or replacement, with patient-specific factors guiding the choice. Post-surgical surveillance plays a vital role in preventing complications and optimizing patient outcomes. The review underscores the significance of advanced cardiac imaging techniques in understanding BAV's complexities, facilitating personalized management strategies, and improving patient care. By harnessing the power of multimodal imaging, clinicians can tailor interventions, monitor disease progression, and ultimately enhance the prognosis and quality of life for individuals with BAV.
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Affiliation(s)
| | - Vito Maurizio Parato
- Cardiology and Rehabilitation Unit, Emergency Department, San Benedetto del Tronto.
| | | | - Naji Kholaif
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Mohammed Al Admawi
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Saif Aljheish
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Lana Arbili
- College of Medicine, Alfaisal University, Riyadh.
| | - Amal Alshammari
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | | | - Hani Al Sergani
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
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9
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Brega C, Albertini A. Aortic Root Surgery in Adults: An Unsolved Problem. AORTA (STAMFORD, CONN.) 2023; 11:29-35. [PMID: 36848909 PMCID: PMC9970757 DOI: 10.1055/s-0042-1757949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Nowadays, despite the rapid advancements in interventional cardiology, open surgery still deals with aortic root diseases, to assure the best "ad hoc" treatment. In case of middle-aged adult patients, the optimal operation still represents a matter of debate. A review of the last 10-year literature was conducted, focusing on patients below 65 to 70 years of age. Because of the small sample and the heterogeneity of the papers, no metanalysis was possible. Bentall-de Bono procedure, valve sparing, and Ross operations are the surgical options currently available. The main issues in the Bentall - de Bono operation are lifelong anticoagulation therapy and cavitation in case of mechanical prosthesis implantation and structural valve degeneration in case of biological Bentall. As transcatheter procedures are currently performed as valve in valve, biological prosthesis may be preferable, if the diameter may prevent postoperative high gradients. Conservative techniques, such as remodeling and reimplantation, preferred in the young, guarantee physiologic aortic root dynamics and impose surgical analysis of the aortic root structures to get a durable result. The Ross operation, which shows excellent performance, involves autologous pulmonary valve implantation and is performed only in experienced and high-volume centers. Due to its technical difficulty, it requires a steep learning curve and presents some limitations in specific aortic valve diseases. All three have advantages and downsides, and no ideal solution has still been reported.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy,Address for correspondence Carlotta Brega, MD Maria Cecilia Hospital, GVM Care and ResearchVia Corriera 1, 48033 Cotignola, RAItaly
| | - Alberto Albertini
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy
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10
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Tsaroev B, Chernov I, Enginoev S, Mustaev M. Survival and freedom from reoperation after the Ross procedure in a Russian adult population: A single-center experience. JTCVS OPEN 2022; 10:140-147. [PMID: 36004253 PMCID: PMC9390578 DOI: 10.1016/j.xjon.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate our 12-year experience with the Ross procedure in adults. Methods A retrospective analysis of 215 cases of the Ross procedure was performed. The mean age of the patients was 36 ± 11.1 years, and the male to female ratio was 75% to 25%, respectively. The pulmonary autograft was placed into the aortic position using the full-root replacement technique and its modified versions. The right ventricular outflow tract was reconstructed using a pulmonary homograft in all cases. Results The 30-day mortality after the operation was 0.9% (2 patients). The median duration of follow-up was 6.1 years (interquartile range, 6.5 years) and was complete in 86% of cases. The survival at 12 years was 94.7% and was comparable with the survival rate of the general population matched for age and sex. At the end of the follow-up, freedom from reoperation due to pulmonary autograft and homograft dysfunction was 89.1% and 99%, respectively. Conclusions In our series, the Ross procedure resulted in low early mortality and excellent survival in adults. The long-term survival was not statistically different from the survival of the general population. The pulmonary homograft offered an excellent durability and freedom from reoperation.
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11
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Shih E, Brinkman WT, Harrington KB, Squiers JJ, Rahimighazikalayeh G, DiMaio JM, Ryan WH. Outcomes of Redo Operations after Ross procedure. J Thorac Cardiovasc Surg 2022; 165:1803-1812.e2. [PMID: 36028359 DOI: 10.1016/j.jtcvs.2022.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Ross procedure is not commonly performed, owing to the procedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedicated Ross center. METHODS We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019. Index and redo operation characteristics and outcomes were compared between patients with and those without redo operations. Multivariate analysis was used to identify independent predictors of Ross-related reinterventions. Survival was estimated with Kaplan-Meier analysis. RESULTS Sixty-six patients (29.3%) required redo Ross surgery, 41 patients (18.2%) underwent autograft reoperation only, 8 patients (3.6%) had a homograft reintervention, and 17 patients (7.6%) had both autograft and homograft reoperations (12 as a combined procedure and 5 as sequential procedures). The mean time to reintervention was 11 ± 6 years for autograft reoperations and 12 ± 7 years for homograft reoperations. Patients who underwent Ross-related reinterventions were younger (mean, 38 ± 11 years vs 43 ± 11 years; P < .01) and had a higher rate of New York Heart Association class III/IV (56% vs 38%; P = .02) at the index Ross procedure. Most patients undergoing autograft reintervention had aortic insufficiency and/or aneurysm (98.2%; 57 of 58). The primary reason for homograft reintervention was pulmonary stenosis (92%; 23 of 25). The operative mortality of Ross reintervention was 1.5% (1 of 66). Survival at 15 years was similar in patients who required a redo operation and those who did not (91.2% vs 93.9%; P = .23). CONCLUSIONS Ross reinterventions can be performed safely and maintain patients at the normal life expectancy restored by the index Ross procedure up to 15 years at experienced centers.
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Affiliation(s)
- Emily Shih
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex; Baylor Scott and White Research Institute, Dallas, Tex.
| | - William T Brinkman
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex
| | - John J Squiers
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex
| | | | - J Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex; Baylor Scott and White Research Institute, Dallas, Tex
| | - William H Ryan
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Tex
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12
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Flynn CD, De Bono JH, Muston B, Rattan N, Tian DH, Larobina M, O'Keefe M, Skillington P. Systematic review and meta-analysis of long-term outcomes in adults undergoing the Ross procedure. Ann Cardiothorac Surg 2021; 10:411-419. [PMID: 34422553 DOI: 10.21037/acs-2021-rp-30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
Background The management of aortic valve disease is becoming increasingly complicated with the evolution of treatment options available to cardiac surgeons and cardiologist. Pulmonary autograft replacement of the aortic valve, commonly known as the Ross procedure, involves excision of the pulmonary valve from the right ventricular outflow tract and implantation in the aortic position. This systematic review aims to evaluate the long-term outcomes, following the Ross procedure. Methods An electronic search strategy queried five online medical referencing databases from inception to 21 August 2020. All studies detailing the long-term outcomes of adults undergoing the Ross procedure were included. A random effects model was used to determine pooled continuous data. Enhanced secondary survival analysis was performed on reconstructed individual patient data. Results Twenty-three studies were included in the qualitative synthesis, including a total of 6,278 patients with a mean follow-up duration of 6.0±2.8 years. Long-term survival was 95.6%, 91.8%, 86.3% and 80.5% at five, ten, fifteen and twenty years, respectively. Freedom from autograft reoperation was 95.7%, 91.2%, 84.9% and 76.1% at five, ten, fifteen and twenty years, respectively. Conclusions When performed in experienced centres and for appropriately selected patients, the Ross procedure represents a durable replacement of the aortic valve with excellent long-term survival.
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Affiliation(s)
- Campbell D Flynn
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia
| | - Joshua H De Bono
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia
| | - Benjamin Muston
- Collaborative Research Group, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - David H Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael O'Keefe
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia.,Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Skillington
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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13
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Vervoort D, El-Hamamsy I, Chu MWA, Peterson MD, Ouzounian M. The Ross procedure and valve-sparing root replacement procedures in the adult patient: do guidelines follow the evidence? Ann Cardiothorac Surg 2021; 10:433-443. [PMID: 34422555 DOI: 10.21037/acs-2021-rp-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Abstract
Prosthetic aortic valve replacements have long been the mainstay of valvular surgery due to their favorable outcomes and low operative complexity. Yet, mechanical valves require lifelong anticoagulation, whereas bioprosthetic valves increase the risk for earlier and more frequent reoperation. Alternative reconstructive techniques have been proposed to address these challenges. These include valve-sparing root replacement procedures if the native aortic valve can be salvaged, and the Ross procedure, which nearly eliminates prosthetic valve-related thromboembolism, anticoagulation-related hemorrhage and endocarditis. Both procedures are technically more complex and thus subject to surgeons' volume and expertise compared to conventional aortic valve replacements. However, they are associated with more favorable outcomes compared to aortic valve replacements if performed by experienced surgeons, especially in younger patients. Nevertheless, despite the growing high-quality literature supporting both procedures, existing multi-society guidelines fail to acknowledge the strength of evidence in support of valve-sparing root replacement procedures and the Ross procedure. In this review, we summarize the existing long-term evidence for the use of each procedure, describe the current guidelines for the treatment of aortic valve pathology, and propose the reevaluation of guidelines based on the available clinical evidence.
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Affiliation(s)
- Dominique Vervoort
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Canada
| | - Mark D Peterson
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
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