1
|
Karianna Milewski RC, Habertheuer A, Bavaria JE, Suhail M, Siki M, Hu R, Freas MA, Ram C, Nanduri A, Szeto WY, Vallabhajosyula P. Long-term outcomes of aortic root procedures for heterogenous ascending aneurysm disease in bicuspid aortic valve syndrome. J Thorac Cardiovasc Surg 2024; 167:2063-2075.e4. [PMID: 36631305 DOI: 10.1016/j.jtcvs.2022.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Surgery for ascending aneurysms in bicuspid aortic valve syndrome primarily includes Bentall root replacement, aortic valve replacement with supracoronary ascending aorta replacement (AVRSCAAR), and valve-sparing root reimplantation (VSRR). Comparative analysis of long-term clinical and functional outcomes of these procedures is detailed. METHODS From 1997 to 2017, 635 patients with bicuspid aortic valve undergoing root complex-focused procedures electively were stratified by valvulopathy (ie, aortic stenosis vs aortic insufficiency) and substratified into ascending or root aneurysm phenotype. Inverse probability weights were calculated to adjust for baseline differences. RESULTS Kaplan-Meier curves for all-cause mortality demonstrated no difference between Bentall versus AVRSCAAR for aortic stenosis and aortic insufficiency presentations (log-rank P > .05). In patients with aortic stenosis, multivariable Cox regression showed significantly decreased risk of stroke for biologic AVRSCAAR (hazard ratio, 0.04; P = .013). Aortic reoperation rates were similar for biologic versus mechanical valves (P = .353). In patients with aortic insufficiency, similar long-term mortality (hazard ratio, 0.95; P = .93), but lower stroke risk in biologic AVRSCAAR group by Cox regression, and lower aortic reoperation rate was noted (coefficient < 0.01; P < .001). Comparing Bentall to VSRR, mortality (hazard ratio, 0.12; P = .022) was significantly improved in patients undergoing VSRR, but recurrence of moderate or greater aortic insufficiency was higher in VSRR by multistate model (beta coefficient 2.63; P < .001). CONCLUSIONS A tailored approach to heterogeneous ascending aneurysm pathologies in bicuspid aortic valve syndrome utilizing Bentall, AVRSCAAR, and VSRR procedures renders excellent long-term clinical and functional outcomes, with biologic conduits showing equivalent to improved clinical outcomes.
Collapse
Affiliation(s)
- Rita Carrie Karianna Milewski
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Andreas Habertheuer
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Maham Suhail
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Mary Siki
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Robert Hu
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Melanie A Freas
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Chirag Ram
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Ananya Nanduri
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Prashanth Vallabhajosyula
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
| |
Collapse
|
2
|
Nijs J, Vangelder B, Tanaka K, Gelsomino S, Van Loo I, La Meir M, Maessen J, Kietselaer BL. Geometric characteristics of bicuspid aortic valves. JTCVS Tech 2021; 10:200-215. [PMID: 34977726 PMCID: PMC8691778 DOI: 10.1016/j.xjtc.2021.08.032] [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: 11/18/2020] [Accepted: 08/19/2021] [Indexed: 12/01/2022] Open
Abstract
Objective We studied the coaptation angles α and β in bicuspid aortic valve geometry from computed tomography scan images. Methods In 45 patients, we calculated the coaptation angle α (the angle between the nonfused commissures crossing the center of coaptation), angle β (between the nonfused commissures crossing the center of the reference circle), angles γ1 and γ2 and ε1 and ε2 (angle between the nonfused commissures and the coaptation point at the raphe or the perfect midpoint, respectively), the length of the raphe, the absolute and relative sinuses' surfaces (relative to the perfect circle and the percentage exceeding the ideal circle). Spearman correlation was employed to investigate the associations among all parameters. Results The coaptation angles α and β were significantly different (P < .001). We found a significant correlation of α with the length of the raphe (P = .008), whereas β was dependent on the position of the commissures. Both γ1 and γ2 (P = .04), or ε1 and ε2 (P < .001) significantly differed from each other and ε2 was the most constant angle, although its size geometrically depends on β. The noncoronary was the largest sinus, and β was the primary determinant of its increased size in bicuspid aortic valves with righ/left fusion pattern. Conclusions The coaptation angle α is influenced by the length of the raphe, whereas angle β is dependent on the position of the commissures. The position of the raphe can vary and is not always situated in the middle of the free edge. The position of the right/non commissure is variable, whereas the right/left commissure is more fixed.
Collapse
Affiliation(s)
- Jan Nijs
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Department of Cardiac Surgery, Brussels Center for Aortic and Cardiovascular Connective Tissue Diseases, University Hospital Brussels, Brussels, Belgium
- Address for reprints: Jan Nijs, MD, Department of Cardiac Surgery, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium.
| | - Babs Vangelder
- Cardiology Division, Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Cardiac Surgery, Brussels Center for Aortic and Cardiovascular Connective Tissue Diseases, University Hospital Brussels, Brussels, Belgium
- Cardio-Radiology Division, Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Sandro Gelsomino
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ines Van Loo
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos Maessen
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiothoracic Surgery Division, Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas L.J.H. Kietselaer
- Cardiology Division, Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
3
|
Hui DS. Commentary: The not-so-basic bicuspid. JTCVS Tech 2021; 9:48. [PMID: 34647058 PMCID: PMC8501253 DOI: 10.1016/j.xjtc.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dawn S. Hui
- Department of Cardiothoracic Surgery, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Tex
| |
Collapse
|
4
|
De Paulis R. The fatal attraction of repairing bicuspid valves. Eur J Cardiothorac Surg 2021; 61:655-656. [PMID: 34568937 DOI: 10.1093/ejcts/ezab412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ruggero De Paulis
- Cardiac Surgery Department, European Hospital, Rome, Italy.,UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| |
Collapse
|
5
|
Romagnoni C, Contino M, Jaworek M, Rosa R, Salurso E, Perico F, Gelpi G, Vismara R, Fiore GB, Mangini A, Antona C. Commissural repositioning in bicuspid aortic valve repair: an in vitro acute model to explore and explain different results. Eur J Cardiothorac Surg 2021; 61:647-654. [PMID: 34363669 DOI: 10.1093/ejcts/ezab359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Commissural orientation <160° is a recognized risk factor for bicuspid aortic valve repair failure. Based on this observation, repairing this subtype of aortic valve by reorienting the 2 commissures at 180° has recently been proposed. METHODS Nine porcine hearts with aortic annulus diameters of 25 mm were selected. A pathological model of a Sievers 1 bicuspid aortic valve was obtained by suturing the coaptation line between the left and right leaflets. Each heart underwent reimplantation procedures both in the native (120°) and the reoriented (180°) configuration. After the operation, each sample was tested on a pulse duplicator at rest (heart rate 60 beats per min) and with mild exercise (heart rate 90 beats per min) conditions. RESULTS No statistically significant difference was noted in mean and peak transvalvular aortic gradients between the 2 configurations at rest (18.6 ± 5 vs 17.5 ± 4 for the mean aortic gradient; 42.8 ± 12.7 vs 36.3 ± 5.8 for the peak aortic gradient) but the group with the 120°-oriented commissures had significantly higher mean transaortic gradients compared to the group with the 180°-oriented commissures at initial exercise stress conditions (30.1 ± 9.1 vs 24.9 ± 3.8; p value 0.002). CONCLUSIONS The 180° commissural reorientation of the asymmetrical bicuspid aortic valve does not improve the transvalvular aortic gradient in an acute model at rest conditions, but it could do so under stress situations. Even if it is surgically more complex and time-consuming, this approach could be a good strategy to improve long-term results, particularly in young patients.
Collapse
Affiliation(s)
- Claudia Romagnoni
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Monica Contino
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Michal Jaworek
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Rubina Rosa
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Eleonora Salurso
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesca Perico
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Guido Gelpi
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Riccardo Vismara
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Gianfranco Beniamino Fiore
- ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Andrea Mangini
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy
| | - Carlo Antona
- Cardiovascular Surgery Department, ASST Fatebenefratelli Sacco, Milano, Italy.,ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milano, Italy.,Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
6
|
Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, Khoynezhad A, Siu SC, Verma S, Hope MD, Cameron DE, Hammer DF, Coselli JS, Moon MR, Sundt TM, Barker AJ, Markl M, Della Corte A, Michelena HI, Elefteriades JA. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg 2019; 156:e41-e74. [PMID: 30011777 DOI: 10.1016/j.jtcvs.2018.02.115] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 01/17/2018] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Bicuspid aortic valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with bicuspid aortic valve disease, with thoracic aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of bicuspid aortic valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of bicuspid aortic valve aortopathy and to guide the daily management of these complex patients.
Collapse
Affiliation(s)
- Michael A Borger
- Leipzig Heart Center, Cardiac Surgery, University of Leipzig, Leipzig, Germany.
| | - Paul W M Fedak
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC
| | - Ali Khoynezhad
- Memorial Care Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, Calif
| | - Samuel C Siu
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hope
- San Francisco (UCSF) Department of Radiology & Biomedical Imaging, University of California, San Francisco, Calif
| | - Duke E Cameron
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Donald F Hammer
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Texas Heart Institute, Baylor College of Medicine, Houston, Tex
| | - Marc R Moon
- Section of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Michael Markl
- Departments of Radiology and Biomedical Engineering, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn
| |
Collapse
|
7
|
Siki MA, Habertheuer A, Bavaria JE, Komlo C, Hunt M, Freas MA, Milewski RK, Desai ND, Szeto WY, Vallabhajosyula P. Two different geometric orientations for aortic neoroot creation in bicuspid aortic valve repair with root reimplantation. J Thorac Cardiovasc Surg 2019; 160:47-57. [PMID: 31982122 DOI: 10.1016/j.jtcvs.2019.06.119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/31/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Bicuspid aortic valve (BAV) represents 2 cusps oriented along a spectrum of equal (180°/180°) or unequal (150°/210°) leaflet surface area distribution along the aortic annular plane. We have taken the approach of respecting the native geometric orientation of the repaired BAV leaflets when creating the aortic neoroot during valve-sparing root reimplantation (VSRR) procedures. We investigated midterm outcomes with this 2-prong approach for VSRR in BAV syndrome. METHODS Of 72 patients in a prospectively maintained BAV repair database, 68 met inclusion criteria: 36 patients had 180°/180° neoroot geometry, and 32 patients had 150°/210° orientation. A multivariate ordinal logistic mixed effects model was performed to study parameters associated with recurrent AI greater than 2+. RESULTS Preoperative parameters were similar between 180°/180° and 150°/210° groups, except for greater incidence of AI 4+ in the latter (50.0% [n = 16] vs 8.3% [n = 3]; P < .001). Postoperatively, stroke, renal failure, reoperation for bleeding, and pacemaker rates were 0 in the entire cohort. In-hospital/30-day mortality in the entire cohort was 1.5% (n = 1). Multivariate ordinal logistic mixed effects model showed that preoperative AI greater than 3+ (odds ratio, 0.4; P = .46) and geometric orientation of the aortic neoroot (odds ratio, 3.8; P = .25) were not significantly associated with recurrence of AI greater than 2+. CONCLUSIONS Respecting BAV geometry for VSRR neoroot creation yields excellent midterm outcomes and may minimize conjoint cusp leaflet stress that may occur in "forcing" a 150°/210° type I BAV into a 180°/180° neoroot.
Collapse
Affiliation(s)
- Mary A Siki
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Andreas Habertheuer
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Caroline Komlo
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Maxwell Hunt
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Melanie A Freas
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Rita K Milewski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | | |
Collapse
|
8
|
Lavon K, Halevi R, Marom G, Ben Zekry S, Hamdan A, Joachim Schäfers H, Raanani E, Haj-Ali R. Fluid-Structure Interaction Models of Bicuspid Aortic Valves: The Effects of Nonfused Cusp Angles. J Biomech Eng 2019; 140:2661744. [PMID: 29098290 DOI: 10.1115/1.4038329] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Indexed: 12/21/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common type of congenital heart disease, occurring in 0.5-2% of the population, where the valve has only two rather than the three normal cusps. Valvular pathologies, such as aortic regurgitation and aortic stenosis, are associated with BAVs, thereby increasing the need for a better understanding of BAV kinematics and geometrical characteristics. The aim of this study is to investigate the influence of the nonfused cusp (NFC) angle in BAV type-1 configuration on the valve's structural and hemodynamic performance. Toward that goal, a parametric fluid-structure interaction (FSI) modeling approach of BAVs is presented. Four FSI models were generated with varying NFC angles between 120 deg and 180 deg. The FSI simulations were based on fully coupled structural and fluid dynamic solvers and corresponded to physiologic values, including the anisotropic hyper-elastic behavior of the tissue. The simulated angles led to different mechanical behavior, such as eccentric jet flow direction with a wider opening shape that was found for the smaller NFC angles, while a narrower opening orifice followed by increased jet flow velocity was observed for the larger NFC angles. Smaller NFC angles led to higher concentrated flow shear stress (FSS) on the NFC during peak systole, while higher maximal principal stresses were found in the raphe region during diastole. The proposed biomechanical models could explain the early failure of BAVs with decreased NFC angles, and suggests that a larger NFC angle is preferable in suture annuloplasty BAV repair surgery.
Collapse
Affiliation(s)
- Karin Lavon
- Faculty of Engineering, School of Mechanical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Rotem Halevi
- Faculty of Engineering, School of Mechanical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gil Marom
- Biomedical Engineering Department, Stony Brook University, Stony Brook, NY 11794
| | - Sagit Ben Zekry
- Echocardiography Laboratory, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Hans Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, Homburg 66421, Germany
| | - Ehud Raanani
- Department of Cardio-thoracic Surgery, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Rami Haj-Ali
- School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
9
|
Miyahara S, Schneider U, Morgenthaler L, Schäfers HJ. (Almost) All Nonstenotic Bicuspid Aortic Valves Should Be Preserved or Repaired. Semin Thorac Cardiovasc Surg 2019; 31:656-660. [DOI: 10.1053/j.semtcvs.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 11/11/2022]
|
10
|
Habertheuer A, Milewski RK, Bavaria JE, Siki M, Freas M, Desai N, Szeto W, Ram C, Hu R, Vallabhajosyula P. Predictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair. Ann Thorac Surg 2018; 106:1316-1324. [DOI: 10.1016/j.athoracsur.2018.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/16/2022]
|
11
|
Tavakoli R, Lebreton G, Gassmann M, Jamshidi P, Leprince P. Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement. J Vis Exp 2017. [PMID: 29286413 DOI: 10.3791/56790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures prevents a number of cardiac surgeons from incorporating them into their practice. The aim of this protocol is to describe a simplified and user-friendly technique of an aortic valve-sparing root replacement (VSRR) procedure by re-implantation of the aortic valve. Proper selection of patients and limitations of the technique are discussed. In 54 consecutive patients, normal appearing aortic valves were re-implanted in a commercially available polyester prosthesis with pre-shaped sinuses by a simplified and standardized technique. Placement of the first row of the proximal suture line, choice of the prosthesis size, and adjustment of the height of the commissures of the patient to the fixed height of the sinus portion of the prosthesis were slightly modified from the reference techniques with the aim of increasing its feasibility for use by other cardiac surgeons. Early mortality and morbidity as well as 5-year survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were collected in all patients. Thirty-day mortality, re-sternotomy for bleeding, re-sternotomy for mediastinitis, and the incidence of stroke were very low, 1.8% for each (1 of 54). No patient required permanent pace-maker implantation. At 5 years, survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were 97.5%, 95.2%, and 91.6%, respectively. Mid-term results of our standardized technique of re-implantation of the aortic valve for valve-sparing aortic root replacement are very good and compare with more complex techniques reported by experienced surgeons. By following the present protocol of the standardized re-implantation technique, a greater number of cardiac surgeons can perform this procedure with comparable good results.
Collapse
Affiliation(s)
- Reza Tavakoli
- Department of Cardiovascular and Thoracic Surgery, Pitie Salpetriere University Hospital, Assistance Publique, Hopitaux de Paris (APHP), Institut de Cardiologie; Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology, University of Zurich;
| | - Guillaume Lebreton
- Department of Cardiovascular and Thoracic Surgery, Pitie Salpetriere University Hospital, Assistance Publique, Hopitaux de Paris (APHP), Institut de Cardiologie
| | - Max Gassmann
- Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology, University of Zurich
| | | | - Pascal Leprince
- Department of Cardiovascular and Thoracic Surgery, Pitie Salpetriere University Hospital, Assistance Publique, Hopitaux de Paris (APHP), Institut de Cardiologie
| |
Collapse
|
12
|
Bicuspid Aortic Insufficiency With Aortic Root Aneurysm: Root Reimplantation Versus Bentall Root Replacement. Ann Thorac Surg 2016; 102:1221-8. [DOI: 10.1016/j.athoracsur.2016.03.087] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/15/2016] [Accepted: 03/22/2016] [Indexed: 11/21/2022]
|
13
|
Ridley CH, Vallabhajosyula P, Bavaria JE, Patel PA, Gutsche JT, Shah R, Feinman JW, Weiss SJ, Augoustides JG. The Sievers Classification of the Bicuspid Aortic Valve for the Perioperative Echocardiographer: The Importance of Valve Phenotype for Aortic Valve Repair in the Era of the Functional Aortic Annulus. J Cardiothorac Vasc Anesth 2016; 30:1142-51. [PMID: 27241768 DOI: 10.1053/j.jvca.2016.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Clare H Ridley
- Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, School of Medicine, Washington University, St. Louis, MO
| | | | | | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ronak Shah
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
14
|
Miyahara S, Abe N, Matsueda T, Izawa N, Yamazato T, Nomura Y, Kitamura A, Sato S, Takahashi H, Inoue T, Matsumori M, Okita Y. Impact of positional relationship of commissures on cusp function after valve-sparing root replacement for regurgitant bicuspid aortic valve. Eur J Cardiothorac Surg 2016; 50:75-81. [DOI: 10.1093/ejcts/ezv438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/17/2015] [Indexed: 01/08/2023] Open
|
15
|
Bavaria JE, Desai N, Szeto WY, Komlo C, Rhode T, Wallen T, Vallabhajosyula P. Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: Comparison with the 3-cusp David procedure. J Thorac Cardiovasc Surg 2015; 149:S22-8. [DOI: 10.1016/j.jtcvs.2014.10.103] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/22/2014] [Accepted: 10/26/2014] [Indexed: 11/16/2022]
|