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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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Bogachev-Prokophiev A, Sharifulin R, Demin I, Karadzha A, Zheleznev S, Karaskov A, Afanasyev A, Pivkin A, Ovcharov M, Zalesov A, Murashov I, Tsaroev B, Chernyavsky A. Redo aortic root surgery post-Ross procedure. Front Cardiovasc Med 2023; 10:1306445. [PMID: 38155981 PMCID: PMC10754512 DOI: 10.3389/fcvm.2023.1306445] [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: 10/03/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023] Open
Abstract
Background Despite numerous advantages of the Ross procedure, it presents a risk of late autograft and right ventricular outflow tract conduit failure. This study aimed to analyze the outcomes of autograft dysfunction reoperations using autograft-sparing and root replacement techniques. Methods Between 2015 and 2023, 49 patients underwent redo root surgery in our institution. Autograft valve-sparing procedures (VSP) were performed in 20 cases and the Bentall procedure (BP) in 29 patients. The short and long-term clinical outcomes along with echocardiographic results of VSP and BP were investigated. Results Overall early mortality rate was 2.0% with no significant difference between the groups. Severe autograft valve insufficiency at the time of redo (OR 4.07, P = 0.03) and patient age (OR 1.07, P = 0.04) were associated with a valve replacement procedure instead of VSP. The median follow-up duration was 34 months. No late deaths occurred in either group. Freedom from VSP failure and aortic prosthesis dysfunction were 93.8% and 94.1% in the VSP and BP groups, respectively. No reoperations were necessary in either group. Conclusion Redo aortic root surgery can be safely performed in patients with autograft failure. Both root replacement and autograft valve-sparing procedures demonstrated acceptable results at mid-term follow-up. Early redo surgery pre-empting severe aortic insufficiency increases the likelihood of preservation of the dilated autograft valve.
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Affiliation(s)
| | - Ravil Sharifulin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Igor Demin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Anastasiia Karadzha
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Sergey Zheleznev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Karaskov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Afanasyev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexey Pivkin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Mikhail Ovcharov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Anton Zalesov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Ivan Murashov
- Department of Pathology, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Bashir Tsaroev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Chernyavsky
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
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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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Shafiei M, Kazemzadeh Y, Martyushev DA, Dai Z, Riazi M. Effect of chemicals on the phase and viscosity behavior of water in oil emulsions. Sci Rep 2023; 13:4100. [PMID: 36907931 PMCID: PMC10008830 DOI: 10.1038/s41598-023-31379-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Due to population growth, the need for energy, especially fossil fuels, is increased every year. Since the costs of exploring new reservoirs and drilling new wells are very high, most reservoirs have passed their first and second periods of life, and it is necessary to use EOR methods. Water-based enhanced oil recovery (EOR) methods are one of the popular methods in this field. In this method, due to the possibility of emulsion formation is high, and by creating a stable emulsion, viscosity and mobility improved. In this study, the parameters affecting the stability and viscosity of the emulsion have been investigated step by step. In the first step, 50% (v/v) of water has been selected as the best water cut. The type of salt and its best concentration was evaluated in the second step by measuring the average droplets size. The third step investigated the effect of SiO2 nanoparticles and surfactant (span80) on emulsion stability and viscosity. According to the results, the best amount of water cut was 50% due to the maximum viscosity. In salts the yield was as follows: MgCl2 > CaCl2 > MgSO4 > Na2SO4 > NaCl. The best yield was related to MgCl2 at a concentration of 10,000 ppm. Finally, it was shown that the synergy of nanoparticles and surfactants resulted in higher stability and viscosity than in the case where each was used alone. It should be noted that the optimal concentration of nanoparticles is equal to 0.1% (w/w), and the optimal concentration of surfactant is equal to 200 ppm. In general, a stable state was obtained in 50% water-cut with MgCl2 salt at a concentration of 10,000 ppm and in the presence of SiO2 nanoparticles at a concentration of 0.1% and span 80 surfactants at a concentration of 200 ppm. The results obtained from this study provide important insights for optimal selection of the water-based EOR operation parameters. Viscosity showed a similar trend with stability and droplet size. As the average particle size decreased (or stability increased), the emulsion viscosity increased.
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Affiliation(s)
- Masoud Shafiei
- Enhanced Oil Recovery Research Center, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran
| | - Yousef Kazemzadeh
- Enhanced Oil Recovery Research Center, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran.
- Department of Petroleum Engineering, Faculty of Petroleum, Gas, and Petrochemical Engineering, Persian Gulf University, Bushehr, Iran.
| | - Dmitriy A Martyushev
- Department of Oil and Gas Technologies, Perm National Research Polytechnic University, Perm, 614990, Russia
| | - Zhenxue Dai
- College of Construction Engineering, Jilin University, Changchun, China
| | - Masoud Riazi
- Enhanced Oil Recovery Research Center, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran.
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Jahanyar J, Mastrobuoni S, de Kerchove L, El Khoury G. Commentary: Keeping Ross on its original trajectory. J Thorac Cardiovasc Surg 2022; 165:1813-1814. [PMID: 35672180 DOI: 10.1016/j.jtcvs.2022.05.006] [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: 05/03/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jama Jahanyar
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Stefano Mastrobuoni
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Laurent de Kerchove
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Gebrine El Khoury
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
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