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Jahanyar J, Pettinari M, El Khoury G, De Kerchove L. Once again the devil is in the details. Eur J Cardiothorac Surg 2024; 66:ezae261. [PMID: 38960733 DOI: 10.1093/ejcts/ezae261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Jama Jahanyar
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Matteo Pettinari
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gébrine El Khoury
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Laurent De Kerchove
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Tran A, Shih E, Harrington KB, Schaffer JM, Banwait JK, Wang Z, DiMaio JM, Mack MJ, Ryan WH, Brinkman WT. Midterm durability of valve-sparing root replacement in bicuspid and tricuspid aortic valves. Proc AMIA Symp 2024; 37:569-575. [PMID: 38910820 PMCID: PMC11188821 DOI: 10.1080/08998280.2024.2346445] [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: 08/02/2023] [Accepted: 04/15/2024] [Indexed: 06/25/2024] Open
Abstract
Background Among patients with bicuspid aortic valves (BAV) who are potential candidates for valve-sparing root replacement (VSRR), the long-term durability of this technique is not well understood. This study aimed to compare the clinical and echocardiographic outcomes of VSRR in those with BAV and tricuspid aortic valve (TAV) morphology. Methods This was a retrospective analysis of patients who underwent VSRR between 2007 and 2021 at a single center. Kaplan-Meier and log-rank analysis were used to estimate and compare freedom from mortality, progression to >2+ aortic insufficiency (AI), and reoperation between groups (BAV vs TAV). Preoperative and postoperative echocardiographic data were collected and assessed for temporal changes in mixed-effect models. Results A total of 185 patients (BAV, n = 52, 28.1%; TAV, n = 133, 71.9%) underwent VSRR. At baseline, BAV patients were younger (42.4 ± 11.6 vs 52.3 ± 12.6 years; P < 0.01) and had more severe AI (47.9% vs 27.0%; P = 0.02). Average cardiopulmonary bypass and cross-clamp times were similar. There were no differences in rates of postoperative complications, intensive care unit or hospital days, or 30-day readmission. TAV patients' 1-, 5-, and 8-year survival rates were 99.2% [95% CI 97.8-100], 96.7% [93.5-99.9%], and 92.2% [85.6-99.3%], respectively. Overall, there were no differences between groups regarding freedom from mortality (P = 0.18), reoperation (P = 0.51), or recurrent >2+ AI (P = 0.97). . Conclusions VSRR can be safely performed on patients with BAV and TAV morphology, yielding similar midterm freedom from mortality, recurrent >2+ AI, and reoperation. This technique should be considered in carefully selected patients with aortic root pathology and BAV anatomy when performed at experienced centers.
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Affiliation(s)
- Anthony Tran
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Emily Shih
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Katherine B. Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Justin M. Schaffer
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | | | - Zuyue Wang
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - J. Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Michael J. Mack
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - William H. Ryan
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - William T. Brinkman
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
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Zhang H. Bicuspid aortic valve repair-current techniques, outcomes, challenges, and future perspectives. Front Cardiovasc Med 2024; 10:1295146. [PMID: 38235290 PMCID: PMC10791802 DOI: 10.3389/fcvm.2023.1295146] [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: 09/15/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
Bicuspid aortic valve (BAV) is a common congenital heart condition that can lead to some valve-related complications, such as aortic stenosis and/or regurgitation, and is often associated with aortic root dilation. With the development and refinement of BAV repair techniques over the past three decades, surgical repair of BAV has emerged as an effective treatment option, offering symptomatic relief and improved outcomes. This review aims to summarize the current techniques, outcomes, and challenges of BAV repair, and to provide potential future perspectives in the field.
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Affiliation(s)
- Haiyu Zhang
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, United Kingdom
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Holubec T, Al-Obaidi M, Walther T, Van Linden A. David procedure through an upper ministernotomy. Ann Cardiothorac Surg 2023; 12:380-382. [PMID: 37554709 PMCID: PMC10405342 DOI: 10.21037/acs-2022-avs2-174] [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: 12/15/2022] [Accepted: 03/28/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Mustafa Al-Obaidi
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
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Jahanyar J, Arabkhani B, Zanella L, de Kerchove L, Tsai PI, Aphram G, Mastrobuoni S, El Khoury G. Valve-sparing operations after Ross procedure: a single-center experience. Ann Cardiothorac Surg 2023; 12:350-357. [PMID: 37554717 PMCID: PMC10405345 DOI: 10.21037/acs-2023-avs2-0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The Ross procedure has demonstrated excellent long-term results, with restoration of life-expectancy in patients with severe aortic valve dysfunction. However, reintervention after Ross can occur, and herein we describe our center's experience with redo surgery after previous Ross procedures. METHODS We searched our prospective database for aortic valve-repair and recruited all adult (≥18 years) patients who have undergone valve-sparing root replacements (VSRRs) and/or aortic valve-repair after Ross procedure between July 2001 and July 2022. Univariable logistic regression analysis was performed to identify variables affecting early mortality. Survival, freedom-from-valve-reintervention and freedom-from-aortic regurgitation (AR) grade ≥3 were analyzed with the Kaplan-Meier method. RESULTS A total of 63 patients were recruited for this study. Indication for reoperation after Ross was aortic aneurysm without AR in 17 (27%), aortic aneurysm with AR in 27 (43%), and isolated AR in 19 (30%) patients. Median follow-up time was 7.82 years. The majority of patients (76%) had undergone the free root technique during their index Ross operation. Cumulative survival, after redo surgery following Ross, was 98.4% [95% confidence interval (CI): 89.3-99.8%] at 1 year, 96.3% (95% CI: 88.2-98.3%) at 5 years, and 92.4% (95% CI: 87.1-98.0%) at 10 years. Freedom-from-reoperation on the aortic valve at 1 year was 98.4% (95% CI: 97.0-99.8%), at 5 years was 96.7% (95% CI: 87.6-99.0%), and 79.7% (95% CI: 71.1-88.3%) at 10 years. CONCLUSIONS Long-term survival after redo surgery following the Ross operation is excellent. The data support our aggressive valve-sparing approach after Ross.
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Affiliation(s)
- Jama Jahanyar
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
- Division of Cardiovascular and Thoracic Surgery, Queen’s Heart Institute, Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Bardia Arabkhani
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Luca Zanella
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
- Division of Cardiac Surgery, Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
| | - Laurent de Kerchove
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Peter I. Tsai
- Division of Cardiovascular and Thoracic Surgery, Queen’s Heart Institute, Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Gaby Aphram
- 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
| | - Gebrine El Khoury
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
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Jahanyar J, de Kerchove L, Tsai PI, Said SM, El Khoury G. Unicuspid aortic valves are no bicuspid aortic valves-It's time to retire the Sievers-classification. J Card Surg 2022; 37:4202-4203. [PMID: 36321719 DOI: 10.1111/jocs.17091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Jama Jahanyar
- Division of Cardiovascular & Thoracic Surgery, Department of Surgery, Queen's Heart Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.,Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Laurent de Kerchove
- Division of Cardiovascular & Thoracic Surgery, Department of Surgery, Queen's Heart Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Peter I Tsai
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Gebrine El Khoury
- Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
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Nappi F, Giacinto O, Lusini M, Garo M, Caponio C, Nenna A, Nappi P, Rousseau J, Spadaccio C, Chello M. Patients with Bicuspid Aortopathy and Aortic Dilatation. J Clin Med 2022; 11:jcm11206002. [PMID: 36294323 PMCID: PMC9605389 DOI: 10.3390/jcm11206002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. Alteration of ascending aorta diameter is a consequence of shear stress alterations due to haemodynamic abnormalities developed from inadequate valve cusp coaptation. (2) Objective: This narrative review aims to discuss anatomical, pathophysiological, genetical, ultrasound, and radiological aspects of BAV disease, focusing on BAV classification related to imaging patterns and flux models involved in the onset and developing vessel dilatation. (3) Methods: A comprehensive search strategy was implemented in PubMed from January to May 2022. English language articles were selected independently by two authors and screened according to the following criteria. (4) Key Contents and Findings: Ultrasound scan is the primary step in the diagnostic flowchart identifying structural and doppler patterns of the valve. Computed tomography determines aortic vessel dimensions according to the anatomo-pathology of the valve. Magnetic resonance identifies hemodynamic alterations. New classifications and surgical indications derive from these diagnostic features. Currently, indications correlate morphological results, dissection risk factors, and genetic alterations. Surgical options vary from aortic valve and aortic vessel substitution to aortic valve repair according to the morphology of the valve. In selected patients, transcatheter aortic valve replacement has an even more impact on the treatment choice. (5) Conclusions: Different imaging approaches are an essential part of BAV diagnosis. Morphological classifications influence the surgical outcome.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
- Correspondence: ; Tel.: +33-1-4933-4104; Fax: +33-1-4933-4119
| | - Omar Giacinto
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Mario Lusini
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Marialuisa Garo
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Claudio Caponio
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Juliette Rousseau
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02115, USA
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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