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Lin XF, Xie LF, Zhang ZF, Wu QS, Qiu ZH, Chen LW. Surgical management of the aortic root in acute type A aortic dissection: A comparative analysis. Int J Cardiol 2024; 410:132182. [PMID: 38754583 DOI: 10.1016/j.ijcard.2024.132182] [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: 01/19/2024] [Revised: 03/13/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study aimed to assess the early- and mid-term outcomes of aortic root repair and replacement, and to provide evidence to improve root management in acute type A aortic dissection (AAAD). METHODS This study enrolled 455 patients who underwent AAAD root repair (n = 307) or replacement (n = 148) between January 2016 and December 2017. Inverse probability of treatment weighting (IPTW) method was used to control for treatment selection bias. The primary outcomes were in-hospital mortality, mid-term survival, and proximal aortic reintervention. RESULTS The success rate of root repair was 99.7%. The in-hospital mortality in the conservative root repair (CRR) and aggressive root replacement (ARR) were 8.1% and 10.8%. The median follow-up time was 67.76 months (IQR, 67-72 months). After adjusting for baseline factors, there was no significant differences in mid-term survival (p = .750) or the proximal aortic reintervention rate (p = .550) between the two groups. According to Cox analysis, age, hypertension, severe aortic regurgitation, CPB time, and concomitant CABG were all factors associated with mid-term mortality. Regarding reintervention, multivariate analysis identified renal insufficiency, bicuspid aortic valve, root diameter ≥ 45 mm, and severe aortic regurgitation as risk factors, while CRR did not increase the risk of reintervention. The subgroup analysis revealed heterogeneity in the effects of surgical treatment across diverse populations based on a variety of risk factors. CONCLUSIONS For patients with AAAD, both CRR and ARR are appropriate operations with promising early and mid-term outcomes. The effects of treatment show heterogeneity across diverse populations based on various risk factors.
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Affiliation(s)
- Xin-Fan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China
| | - Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China
| | - Zhao-Feng Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China
| | - Qing-Song Wu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China
| | - Zhi-Huang Qiu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China.
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China.
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Haider Jeoffrey SM, Zafar MA, Velasco J, Khattak A, Ellauzi H, Nasir A, Kalyanasundaram A, Ziganshin BA, Elefteriades JA. Midterm follow-up of composite graft replacement of the aortic root (30-year experience)-remarkably safe, effective, and durable. JTCVS OPEN 2024; 17:1-13. [PMID: 38420531 PMCID: PMC10897671 DOI: 10.1016/j.xjon.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 03/02/2024]
Abstract
Objectives Contemporary operative choices for aortic root disease include aortic root replacement (ARR) and a variety of valve-sparing and aortic root-repair procedures. We evaluate ultra-long-term outcomes of ARR, focusing on survival, freedom from late reoperation, and adverse events. Methods Prospectively kept records were used to accomplish long-term follow-up of patients who underwent ARR (4-pronged Yale survival assessment paradigm). Results Between 1990 and 2020, 564 patients underwent ARR (mean 56 years, 84% male). A modified Cabrol procedure (Dacron coronary graft) was employed in 9.0% (51/564) and concomitant coronary artery bypass grafting in 9.4% (53/564). There were 12.8% (72/564) urgent/emergent and 7.4% (42/564) redo procedures. Operative mortality occurred in 12 patients (2.1%) overall, or 1.4% (8/554) of nondissection and 1.3% (6/468) of elective first-time operations. Six of the 12 deaths presented with acute type A dissection, urgent operation, or reoperative states. Operative mortality dropped to 0.6% during the past 10 years. In total, 11 patients developed endocarditis. Stroke occurred in 11 of 564 patients (2.0%), 4 of whom had presented with type A dissection. Late events included bleeding in 2.8% (16/564), thromboembolism in 1.4% (8/564), and reoperation of the root in 5 of 564 (0.9%) at 15 years and more distal aortic segments in 16/564 (2.8%). Survival was no different from age/sex-matched controls. Conclusions This ultra-long-term experience finds ARR to be extraordinarily safe, effective, and durable, with minimal long-term bleeding, thromboembolism, or graft failure. This experience provides a standard of durability for ARR against which ultra-long-term outcomes with alternate procedures (valve-sparing, Ross, other) may be compared.
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Affiliation(s)
| | - Mohammad A. Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Juan Velasco
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Ahad Khattak
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Hesham Ellauzi
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Afsheen Nasir
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Asanish Kalyanasundaram
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - John A. Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
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Ugurlucan M, Beyaz MO, Oztas DM, Ozturk A, Sahinoglu K, Alpagut U, Bozbuga N. The Geometrical Modeling of Aortic Root Complex. Heart Views 2019; 20:6-10. [PMID: 31143380 PMCID: PMC6524420 DOI: 10.4103/heartviews.heartviews_115_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: This study was designed to investigate the anatomical relationship of the different levels of aortic root. Materials and Methods: The morphological features of the aortic root were examined using of 12 adult hearts from fixed male cadavers who had expired due to noncardiac causes by magnetic resonance imaging and applied mathematical analyses to the results. The measurements of the aortic root were done at four levels: at the ventriculoarterial junction (annulus), at the largest level of the Valsalva sinuses (sinus), at the level of commissures (sinotubular junction [STJ]), and at 1 cm above the STJ (aorta ascendens). We derived an equation that allows calculation of the appropriate diameter of the aortic root from four levels. Statistical analysis among the variation of the diameters at the four levels of aortic root was achieved using test one-way analysis of variance. Results: The data showed a geometric pattern of the aortic root. The comparison of the values from four levels showed that the narrowest at the sinotubular junctional level and the widest at the sinus level. Conclusion: The analysis of our data shows that the aortic root has a consistent shape with varying size and that is a definable mathematical relationship between root diameter.
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Affiliation(s)
- Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - Metin Onur Beyaz
- Cardiovascular Surgery Clinic, Sultanbeyli State Hospital, Istanbul, Turkey
| | - Didem Melis Oztas
- Cardiovascular Surgery Clinic, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Adnan Ozturk
- Department of Anatomy, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Kayihan Sahinoglu
- Department of Anatomy, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Nilgun Bozbuga
- Department of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Kaya E. Reinforcement of suture lines with aortic eversion in aortic replacement. Cardiovasc J Afr 2018; 29:12-45. [PMID: 29443351 PMCID: PMC6002793 DOI: 10.5830/cvja-2017-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/12/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In this study, we describe the technique of eversion of the native aortic tissue to prevent suture line complications, and report on our results with this technique. METHODS A total of 42 patients who were operated on due to aortic aneurysm were retrospectively assessed. In all patients, an aortic segment of approximately 2 cm, which was left both distally and proximally, was everted to form a double-layer lumen and the grafts were anastomosed. Postoperative outcomes and long-term follow-up results were assessed. RESULTS Aortic root replacement was done in 14 cases and eight subjects underwent concurrent coronary artery bypass surgery. Postoperatively, the average volume of the drainage was 375 ± 75 ml, and there were no re-operations. Twenty-seven patients required blood transfusion. CONCLUSIONS Reinforcement of the anastomosis line via eversion of the native aortic tissue reduced peri-operative blood loss and pseudo-aneurysm and infection, with the advantage of using viable tissue.
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Affiliation(s)
- Erhan Kaya
- Private Pendik Regional Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey.
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Mok SCM, Ma WG, Mansour A, Charilaou P, Chou AS, Peterss S, Tranquilli M, Ziganshin BA, Elefteriades JA. Twenty-five year outcomes following composite graft aortic root replacement. J Card Surg 2016; 32:99-109. [PMID: 27966257 DOI: 10.1111/jocs.12875] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Operative choices for aortic root disease include traditional root replacement with a composite valved graft as well as various valve-sparing and root repair procedures. OBJECTIVES To report our experience with traditional composite graft aortic root replacement by a single surgeon over a 25-year period in 449 patients, focusing on long-term survival and freedom from late reoperation and adverse events. METHODS The coronary button technique was used in all patients. Mean age was 56.1 ± 14.0 years (range 14-87) with 83% males (373/449). Valve prosthesis was mechanical in 343 (76%) and bioprosthetic in 106 (24%). A modified Cabrol procedure (Dacron coronary graft) was employed in 10% (45/449) and concomitant coronary artery bypass graft in 10.9% (49/449). There were 15.8% (71/449) urgent/emergent and 8.2% (37/449) redo procedures. Survival follow-up was 100%. Mean follow-up was 7.0 ± 5.1 years (range 0.1-24.8). RESULTS Operative mortality occurred in 14 patients (3.1%) and was 2.2% (9/418) in non-dissection and 1.9% (7/361) in elective first-time operations. Stroke and re-exploration for bleeding occurred in nine (2.0%) and 20 (4.5%) patients, respectively. Major late events included bleeding in 2.5% (11/435) and thromboembolism in 1.1% (5/435). At 5, 10, and 20 years, freedom from major events and reoperations on the root were 97.8, 95.4, and 94.39%, and 99.0, 99.0, and 97.9%, respectively. Survival in patients aged <60 years was 92.0, 90.1, and 79.8% at five, 10, and 20 years versus 88.4, 67.9, and 42.6% in patients aged ≥60 years (p = 0.001). Compared with age- and gender-matched controls, survival was not significantly different (p = 0.20). CONCLUSIONS Composite graft aortic root replacement is associated with low operative risk, excellent long-term survival, and low incidence of reoperation and late events.
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Affiliation(s)
- Salvior C M Mok
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Wei-Guo Ma
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.,Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ahmed Mansour
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Paris Charilaou
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Alan S Chou
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Sven Peterss
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.,Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
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Waldmann V, Milleron O, Iung B, Messika-Zeitoun D, Lepage L, Ghodbane W, Brochet E, Vahanian A, Nataf P, Jondeau G. Is Transesophageal Echocardiography Needed before Hospital Discharge in Patients after Bentall Surgery? J Am Soc Echocardiogr 2016; 30:52-58. [PMID: 27843101 DOI: 10.1016/j.echo.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Indexed: 01/16/2023]
Abstract
BACKGOUND Whether transesophageal echocardiography (TEE) should be routinely performed before hospital discharge after Bentall surgery remains unclear. The investigators took advantage of this practice at their institution to evaluate its benefit. METHODS All patients who had undergone the Bentall procedure at Bichat Hospital from January 2010 to March 2014 were included. For each patient, transthoracic echocardiographic and transesophageal echocardiographic data and clinical events were retrospectively collected from the various reports. RESULTS One hundred ninety-eight patients underwent the Bentall procedure during the study period. Postoperative TEE was performed in 117 patients (59.1%), including nine with abnormalities observed on transthoracic echocardiography (a vibrating element on the new prosthetic valve, suspicion of peritubular complications in two patients, and aortic regurgitation in six patients). In 108 patients, routine TEE was performed (i.e., without clinical indication beyond baseline postoperative imaging). Patients with and those without routine TEE were identical, except for more frequent endocarditis as an indication for surgery in patients with routine TEE. Routine TEE did not reveal any new findings that prior transthoracic echocardiography had not shown. The most frequent finding on transthoracic echocardiography or TEE was periaortic hematoma, which sometimes led to the performance of computed tomography. This imaging did not change the care of the patients in this population. CONCLUSIONS This study does not support the performance of TEE after Bentall surgery during the in-hospital course in the absence of a specific indication. Baseline postoperative imaging using TEE or computed tomography should preferably be recommended beyond the early postoperative period after periaortic hematoma has resolved.
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Affiliation(s)
| | | | - Bernard Iung
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - Laurent Lepage
- Department of Cardiac Surgery, Bichat Hospital, Paris, France
| | - Walid Ghodbane
- Department of Cardiac Surgery, Bichat Hospital, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Hospital, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - Patrick Nataf
- Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; Department of Cardiac Surgery, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - Guillaume Jondeau
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
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Kirali K, Erentuğ V, Rabuş MB, Izgi A, Bozbuğa NU, Erkanli K, Akinci E, Yakut C. Extensive Aortic Surgery in Marfan Syndrome: 16-Year Experience. Asian Cardiovasc Thorac Ann 2016; 11:337-41. [PMID: 14681096 DOI: 10.1177/021849230301100414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the clinical outcome of surgical treatment in patients with Marfan syndrome. Between 1985 and November 2001, 33 patients with Marfan syndrome were operated for chronic aneurysm of the aortic root with involvement of the ascending aorta in 20 patients and type A dissection in 13 patients. The patients comprised 24 males and 9 females with a mean age of 31.9 ± 9.7 years (range, 18 to 54 years). The mean diameter of the ascending aorta was 6.6 ± 1.6 cm and that of the aortic root was 5.4 ± 1.2 cm. Hemodynamic instability was observed in 11 patients. The aortic arch was replaced in 7 patients. There was no hospital mortality. Late mortality was 6%, involving 2 patients who had aortic valve replacement. Actuarial freedom from death was 92.3% ± 7.4% at 12 years and from late aortic complications was 86.4% ± 9.4% at 13 years. Aortic aneurysm was a significant univariate adverse factor for late aortic complications. Aortic surgery can be performed in Marfan patients with low morbidity and mortality. Aggressive surgical intervention does not impair surgical outcome while it decreases reoperation risk.
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Affiliation(s)
- Kaan Kirali
- Department of Cardiovascular Surgery. Koşuyolu Heart and Research Hospital, Kadikoy 81020, Istanbul, Turkey.
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Kirali K, Sarikaya S, Ozen Y, Sacli H, Basaran E, Yerlikhan OA, Aydin E, Rabus MB. Surgery for Aortic Root Abscess: A 15-Year Experience. Tex Heart Inst J 2016; 43:20-8. [PMID: 27047281 DOI: 10.14503/thij-14-4747] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit.
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Salve GG, Mavanoor SS, Rajanna V, Prakash D, Sreedhar K. Double reinforcement of proximal anastomosis in Bentall procedure: a new technique. Indian J Thorac Cardiovasc Surg 2013. [DOI: 10.1007/s12055-013-0228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Koshiyama H, Nakajima M, Amenomori S, Tsuchiya K. A refined flanged Bentall technique using Valsalva tube graft for proximal reinforcement. Eur J Cardiothorac Surg 2011; 40:1537-9. [PMID: 21497105 DOI: 10.1016/j.ejcts.2011.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 02/27/2011] [Accepted: 03/02/2011] [Indexed: 11/17/2022] Open
Abstract
Bleeding from the proximal suture line during aortic root replacement using a composite valve graft is a crucial and catastrophic problem. We present a simple flanged Bentall technique using a Valsalva tube graft to eliminate bleeding from the proximal suture line. The method is to wrap the proximal anastomosis completely by sewing the Valsalva flange to the residual aortic wall. The wrapping is facilitated by the use of part of a horizontally stretching Valsalva graft. This refined technique is effective and reproducible to prevent bleeding from the proximal suture line after the Bentall procedure.
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Affiliation(s)
- Hiroshi Koshiyama
- Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan.
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Polat A, Uyar I, Mataraci I. A modified composite graft for prevention of postoperative bleeding from the proximal anastomosis. Ann Thorac Surg 2010; 90:699-700; author reply 700. [PMID: 20667397 DOI: 10.1016/j.athoracsur.2010.01.027] [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: 11/13/2009] [Revised: 11/13/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
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Izgi C, Mansuroglu D. Flanged and skirted dacron grafts: modifications of the composite graft used in Bentall procedure. Ann Thorac Surg 2010; 90:699; author reply 699. [PMID: 20667396 DOI: 10.1016/j.athoracsur.2010.01.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 12/29/2009] [Accepted: 01/13/2010] [Indexed: 11/29/2022]
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13
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Mataraci I, Polat A, Kıran B, C̨alışkan A, Tuncer A, Erentug V, Kirali K, Isik O, Yakut C. Long-Term Results of Aortic Root Replacement: 15 Years' Experience. Ann Thorac Surg 2009; 87:1783-8. [DOI: 10.1016/j.athoracsur.2009.03.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 03/14/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
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Ghavidel AA, Tabatabaei MB, Yousefnia MA, Omrani GR, Givtaj N, Raesi K. Mortality and morbidity after aortic root replacement: 10-year experience. Asian Cardiovasc Thorac Ann 2008; 14:462-6. [PMID: 17130319 DOI: 10.1177/021849230601400604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortic root reconstruction remains a challenging surgical procedure. This retrospective study was carried out to evaluate the early and long-term outcomes of aortic root replacement over a 10-year period. There were 83 patients with a mean age of 43.2 +/- 14 years (range, 10 to 78 years). Type A aortic dissection and Marfan syndrome were found in 28% and 24%, respectively. The most common technique used for repair of this condition was the Bentall operation. The mean duration of follow-up was 29.6 +/- 28 months, ranging from 1 to 120 months. Hospital (30-day) mortality was 13.3% (11 patients). Two patients died during the late follow-up. The mortality was significantly higher in patients presenting with cardiogenic shock, those with long cardiopulmonary bypass and crossclamp times, and the group who had concomitant coronary artery bypass grafting. Emergency operation was not a significant risk factor for early death in our patients. The most common complications were bleeding and neurological sequelae. Aortic root replacement can be achieved with acceptable mortality and morbidity in a high-risk group of patients. Improvements in the outcome may be achieved by faster transport of patients in cardiogenic shock, and by reducing the cardiopulmonary bypass and crossclamp times.
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Affiliation(s)
- Alireza A Ghavidel
- Rajaee Heart Centre, Iran University of Medical Sciences, Vali-e-Asr Avenue, Tehran, Iran.
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Stalder M, Staffelbach S, Immer FF, Englberger L, Berdat PA, Eckstein FS, Carrel TP. Aortic root replacement does not affect outcome and quality of life. Ann Thorac Surg 2007; 84:775-80; discussion 780-1. [PMID: 17720374 DOI: 10.1016/j.athoracsur.2007.04.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 04/18/2007] [Accepted: 04/23/2007] [Indexed: 12/28/2022]
Abstract
BACKGROUND Different studies have analyzed the potential impact of the underlying pathologic process and the use of deep hypothermic circulatory arrest on outcome and quality of life after surgery on the thoracic aorta. The aim of this study is to analyze the impact of different surgical procedures on outcome and quality of life. METHODS Between June 2001 and December 2003, 244 patients underwent surgery for various diseases of the ascending aorta with or without involvement of the aortic valve or root. They were divided according to the operative procedure: 76 patients (31.2%) underwent isolated replacement of the ascending aorta, 42 patients (17.2%) received separate aortic valve replacement and supracoronary replacement of the ascending aorta, 86 patients (35.2%) received a mechanical composite graft, and 40 patients (16.4%) received a biologic composite graft. All in-hospital data were assessed, and a follow-up was performed in all survivors after 26.6 +/- 8.8 months, focusing on outcome and quality of life (SF-36). RESULTS Overall in-hospital mortality was 6.1%, and late mortality was 5.7%, with no significant difference between groups. Independent of the surgical technique and the extent of surgery, there was no difference in quality of life between the surgical collective and an age-matched and sex-matched standard population. CONCLUSIONS Operations of the ascending aorta and aortic valve are very safe, with low in-hospital mortality and favorable midterm outcome regarding late mortality and morbidity. Quality of life after operations of the ascending aorta and aortic valve is equal to a standard population and is not affected by the surgical procedure. Liberal use of aortic root replacement is therefore justified to radically treat the diseased aortic segment.
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Affiliation(s)
- Mario Stalder
- Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland.
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Yoshikai M, Ito T, Ohnishi H, Kamohara K, Fumoto H, Furutachi A. A Safer Technique of Aortic Root Replacement After Aortic Valve Replacement. Surg Today 2006; 36:201-3. [PMID: 16440174 DOI: 10.1007/s00595-005-3127-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 05/24/2005] [Indexed: 10/25/2022]
Abstract
Aortic root replacement after aortic valve replacement (AVR) is often complicated by bleeding around the aortic root, which increases the risk of morbidity and mortality, making it a technically challenging procedure. We describe a new technique of aortic root replacement designed to minimize bleeding around the aortic root. This surgical technique focuses on safe dissection and exposure of the aortic root to avoid inadvertent entry into the right atrium or right ventricle; on modifying the proximal anastomosis of the graft to the aortic annulus; and on performing a coronary artery reimplantation that achieves complete hemostasis at the suture lines. We performed aortic root replacement after AVR in four patients over a 4-year period, without encountering any bleeding around the aortic root.
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Affiliation(s)
- Masaru Yoshikai
- Department of Cardiovascular Surgery, Shin-Koga Hospital, 120 Tenjin-cho, Kurume, Fukuoka, 830-8577, Japan
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Abstract
Aortic root pathology is a common cause of aortic insufficiency. Aortic root aneurysm and aortic dissection, if left untreated, carry significant risk of mortality and morbidity. Surgical treatment involves replacement of the aortic valve, sinuses and ascending aorta. A number of prosthetic options have been developed including composite valve-synthetic graft, xenograft, homograft and pulmonary autograft. The current review describes the two main indications for aortic root replacement surgery, aortic dissection and root aneurysm, and discusses the various operative strategies and outcomes.
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Affiliation(s)
- Gilbert H L Tang
- University of Toronto, Toronto General Hospital, 4N-451, Toronto, Ontario M5G 2C4, Canada.
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Kurisu K, Ochiai Y, Kajiwara T, Kumeda H, Tominaga R. A modified valve-on-valve approach for aortic root replacement. Ann Thorac Surg 2003; 76:2099-101. [PMID: 14667659 DOI: 10.1016/s0003-4975(03)00743-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe an alternative surgical technique for aortic root replacement in a patient whose aortic valve was previously replaced with a bioprosthesis. It consists of resecting the leaflets of the original bioprosthesis in situ, amputating the struts, and suturing the skirt of a composite graft on the preserved annulus of the original bioprosthesis. Coronary circulation is reconstructed according to the Cabrol modification. This approach simplifies and shortens the procedure of aortic root replacement, minimizing the potential hazard of hemorrhage from the proximal suture line in these cases.
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Affiliation(s)
- Kazuhiro Kurisu
- Department of Cardiovascular Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
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