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Yang S, Zhang YY, Zi YF, Pu L, Qian X, Ren L, Li YB, Jin ZH, Liu JF, Yuan Z, Li YX. Cabrol procedure and its modifications: a systematic review and meta-analysis. J Cardiothorac Surg 2024; 19:153. [PMID: 38532449 DOI: 10.1186/s13019-024-02642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The Cabrol procedure has undergone various modifications and developments since its invention. However, there is a notable gap in the literature regarding meta-analyses assessing it. METHODS A systematic review and meta-analysis was conducted to evaluate the effectiveness and long-term outcomes of the Cabrol procedure and its modifications. Pooling was conducted using random effects model. Outcome events were reported as linearized occurrence rates (percentage per patient-year) with 95% confidence intervals. RESULTS A total of 14 studies involving 833 patients (mean age: 50.8 years; 68.0% male) were included in this meta-analysis. The pooled all-cause early mortality was 9.0% (66 patients), and the combined rate of reoperation due to bleeding was 4.9% (17 patients). During the average 4.4-year follow-up (3,727.3 patient-years), the annual occurrence rates (linearized) for complications were as follows: 3.63% (2.79-4.73) for late mortality, 0.64% (0.35-1.16) for aortic root reoperation, 0.57% (0.25-1.31) for hemorrhage events, 0.66% (0.16-2.74) for thromboembolism, 0.60% (0.29-1.26) for endocarditis, 2.32% (1.04-5.16) for major valve-related adverse events, and 0.58% (0.34-1.00) for Cabrol-related coronary graft complications. CONCLUSION This systematic review provides evidence that the outcomes of the Cabrol procedure and its modifications are acceptable in terms of mortality, reoperation, anticoagulation, and valve-related complications, especially in Cabrol-related coronary graft complications. Notably, the majority of Cabrol procedures were performed in reoperations and complex cases. Furthermore, the design and anastomosis of the Dacron interposition graft for coronary reimplantation, considering natural anatomy and physiological hemodynamics, may promise future advancements in this field.
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Affiliation(s)
- Sen Yang
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ya-Yong Zhang
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yun-Feng Zi
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lei Pu
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xu Qian
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Le Ren
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yong-Bo Li
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Hao Jin
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jian-Feng Liu
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhuo Yuan
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ya-Xiong Li
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Du T, Wang W, Wang Y, Piao H, Liu K. Research Progress on Aortic Root Aneurysms. Med Sci Monit 2024; 30:e943216. [PMID: 38332569 PMCID: PMC10863338 DOI: 10.12659/msm.943216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Aortic root aneurysms are one of the most common aortic root diseases, involving the aortic valve, aortic sinus, bilateral coronary arteries, and part of the ascending aorta. It is a life-threatening aortic disease with a high mortality rate of approximately 90%, due to aortic aneurysm rupture. Aortic valve insufficiency is one of the most common complications of aortic root aneurysms that can lead to acute left heart failure. The etiology of aortic root aneurysms is not yet completely clear and is mainly related to genetic diseases, such as Marfan syndrome and atherosclerosis. It can also occur secondary to aortic valve stenosis or a bivalve deformity. Surgery is the primary treatment for aortic root aneurysms, and aortic root replacement is a classic surgical method. However, the incidences of perioperative complications and mortality are relatively high, particularly in high-risk patients. In recent years, the anatomical structure of the aortic root has been gradually refined, and an in-depth understanding of root aneurysms has led to individualized treatment methods. Conservative drug therapy (ß-receptor blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers), Bentall and modified Bentall surgeries (Button technology, Cabrol surgery, and modified Cabrol surgery), valve-sparing aortic root replacement (David and Yacoub), personalized external aortic root support, and endovascular intervention therapy have significantly improved the perioperative and long-term survival rates of patients with aortic root aneurysms. However, different treatment methods have their own advantages and disadvantages. This review aimed to summarize the current research progress and treatment of aortic root aneurysms.
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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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Alavi M, Abdinejad M, Rezaei M, Moaref A. Evaluation of vascular graft infection following Bentall surgery using 18F-FDG PET/CT scan: A pediatric case report. Clin Case Rep 2024; 12:e8396. [PMID: 38161628 PMCID: PMC10756944 DOI: 10.1002/ccr3.8396] [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: 04/20/2023] [Revised: 10/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
Key Clinical Message After a Bentall surgery, there is a small chance of developing a serious complication called vascular graft infection. 18F-FDG PET/CT, a new and accurate diagnostic tool, can help detect it early, especially if the symptoms are unusual. Abstract A 14-year-old boy who had undergone Bentall surgery 1 year prior presented with symptoms of fever, chills, loss of appetite, and weight loss over the course of a month. The initial Bentall surgery was performed due to an aneurysm of the thoracic aorta, along with severe aortic valve insufficiency and moderate aortic valve stenosis. The patient was referred to the PET/CT department for evaluation of possible endarteritis or infection of Dacron graft, which had been reported in trans-esophageal echocardiography as suspicious findings. Despite normal blood tests, blood cultures, and other imaging modalities, the 18F-FDG PET/CT confirmed the diagnosis of vascular graft infection. This diagnostic tool allowed for timely and appropriate treatment and prevention of possible complications.
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Affiliation(s)
- Mehrosadat Alavi
- Ionizing and Non‐Ionizing Radiation Protection Research Center School of Paramedicine SciencesShiraz University of Medical SciencesShirazIran
| | - Maryam Abdinejad
- Department of Nuclear Medicine, School of MedicineShiraz University of Medical SciencesShirazIran
- Nuclear Medicine and Molecular Imaging Research CenterNamazi Teaching Hospital, Shiraz University of Medical SciencesShirazIran
| | - Mehdi Rezaei
- Department of CardiologyFars‐Iranian Heart Association Fars Society of Internal MedicineShirazIran
| | - Alireza Moaref
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
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Sicim H, Ulucan AE, Yurdakök O, Aydemir NA. Pediatric Bentall procedure for giant ascending aortic aneurysm in Loeys-Dietz syndrome. Ann Pediatr Cardiol 2023; 16:223-225. [PMID: 37876949 PMCID: PMC10593284 DOI: 10.4103/apc.apc_22_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 10/26/2023] Open
Abstract
Ascending aortic aneurysm is very rare in children, and is usually seen in patients with underlying connective tissue disorders such as Marfans and Ehler-Danlos syndrome. Loeys-Dietz syndrome (LDS) is less commonly seen as a cause of ascending aortic aneurysms in children. In this case report, we describe pediatric Bentall procedure, which we successfully performed to a child with LDS (Type I) with giant ascending aortic enlargement and significant aortic regurgitation.
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Affiliation(s)
- Hüseyin Sicim
- Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Ertan Ulucan
- Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Yurdakök
- Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan Ali Aydemir
- Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Wahbah Makhoul G, Mustafa A, Ling J, Asogwa N, Elhosseiny S, Siddiqui FS, Khan S, Lafferty JC, Glaser A. Lactococcus endocarditis after Bentall procedure presenting with intracranial hemorrhage. IDCases 2023; 31:e01710. [PMID: 36845909 PMCID: PMC9945769 DOI: 10.1016/j.idcr.2023.e01710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
Background Endocarditis is more common in patients with cardiac prostheses. A Bentall procedure entails surgical replacement of the aortic valve, aortic root, and ascending aorta with re-implantation of coronary arteries into the graft. Case 65-year-old male with history of atrial fibrillation on rivaroxaban, bicuspid aortic valve, and ascending aortic aneurysm with a history of a Bentall procedure two years prior, presented with headache and dysarthria for one day. National Institutes of Health Stroke Scale was 3 and CT head showed 2.7 cm left frontal hematoma with extension into the subarachnoid space. Andexanet alfa was given for rivaroxaban reversal followed by cerebral angiogram which showed 5 mm intracranial inferior MCA aneurysm and embolization and coil placement was done. Blood cultures grew Lactococcus garvieae and transesophageal echocardiogram revealed aortic valve thickening and vegetation on the non-coronary cusp. He was subsequently treated with six weeks of IV ceftriaxone and Gentamycin. Conclusion With increasing use of bioprosthetic valves, the possibility of infective endocarditis with uncommon pathogens should be kept in mind. Lactococcus commonly affects native valves, however it can affect bioprosthetic valves and can present with mycotic aneurysms.
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Affiliation(s)
- Gennifer Wahbah Makhoul
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
- Correspondence to: 475 Seaview Avenue, Staten Island 10305, NY, USA.
| | - Ahmad Mustafa
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Joanne Ling
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Nnedindu Asogwa
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Sherif Elhosseiny
- Department of Cardiology, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Fasih Sami Siddiqui
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Shahkar Khan
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - James C. Lafferty
- Department of Cardiology, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Allison Glaser
- Department of Infectious Diseases, Staten Island University Hospital, Staten Island 10305, NY, USA
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Keijmel SP, Zwartkruis IMM, Jongenotter J, Geuzebroek GSC, Kouijzer IJE. Postoperative Inflammation and Fever After Elective Aortic Valve and Aortic Root Replacement: A Retrospective Cohort Study. Open Forum Infect Dis 2023; 10:ofad015. [PMID: 36726552 PMCID: PMC9887259 DOI: 10.1093/ofid/ofad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background Fever after cardiac surgery is common. More knowledge of postoperative fever could lead to better patient selection for diagnostic workup and empirical antibiotic treatment. We aimed to analyze the postoperative course of inflammation and fever after elective aortic valve and aortic root replacement. Methods In a retrospective single-center cohort study, we included 3 groups of patients after elective cardiac surgery: aortic root with aortic valve replacement (Bentall procedure, from 2014 to 2021), valve-sparing root replacement (VSRR, from 2014 to 2021), and isolated surgical aortic valve replacement (SAVR, from 2018 to 2021). Exclusion criteria were age <18 years, cardiac surgery other than described, use of deep-hypothermic circulatory arrest, reoperations, and preexisting infections. Primary outcome measure was the number of patients per group with postoperative fever (≥38°C). Secondary outcome measures were the percentage of patients per group with infections and outcome. Results Among 307 patients included (76 Bentall, 40 VSRR, 191 SAVR), 71% had postoperative fever. Fever occurred significantly more often in the Bentall (84%) and VSRR group (83%) compared with patients after SAVR (64%, P = .001). Seventeen patients had fever due to infection versus 202 with diagnoses of postoperative inflammation. In case of infection, fever was significantly higher (38.8°C vs 38.4°C, P = .03), and both the number of days with fever and hospital admission duration were significantly longer. Conclusions Postoperative fever is more often observed after Bentall procedure and VSRR compared to SAVR. In diagnoses of infection, there is a higher and prolonged fever.
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Affiliation(s)
- Stephan P Keijmel
- Correspondence: Stephan Keijmel, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands (); Ilse Kouijzer, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ()
| | - Iris M M Zwartkruis
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jochem Jongenotter
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse J E Kouijzer
- Correspondence: Stephan Keijmel, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands (); Ilse Kouijzer, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ()
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Al-Mudhaffar SS, Alwan A, Ouj R, Mowaffaq A, Kakamad FH, Ahmad OF, Mohammed-Saeed DH, Ali RK, Abdalla BA, Mohammed SH, Salih AM. Bentall procedure as a lifesaving surgery: A single center experience. MEDICINE INTERNATIONAL 2023; 3:8. [PMID: 36733412 PMCID: PMC9887084 DOI: 10.3892/mi.2023.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023]
Abstract
The Bentall procedure is a surgical technique used in the management of aortic root abnormalities with ascending aorta and aortic valve issues. The present study aimed to evaluate the outcomes of 18 patients treated with the Bentall procedure in a single center. The present study was a single-center retrospective case series conducted over a period of 3 years. The patients had either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction. The Bentall procedure was performed via standard median sternotomy. St. Jude Medical composite grafts with a valve were applied in all cases. A total number of 18 patients with either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction were included in the study. The age of the participants ranged from 27-60 years. The ratio of males to females was 16:2 (males, 88.8%). The symptoms developed 3-4 days prior to hospital admission. Chest pain was the most common presenting symptom (n=10, 55.5%). Hypertension was the most common risk factor (n=12, 66.6%). In total, 14 cases underwent emergency surgery (77.7%). The emergency surgery was performed in 9 patients within 24 h of arrival owing to the association of aortic root dissection with tamponade. For the other cases, the surgery was performed within 2 and 7 days (n=5, 27.7% and n=4, 22.2%) respectively. Early post-operative complications occurred in 5 patients (27.7%). On the whole, as demonstrated herein, the modifications of the Bentall procedure have a notable impact on decreasing the overall mortality rates. Raising the awareness of clinicians and the general population as regards aortic dissection may aid in the early referral of patients to specialized centers and may thus decrease the overall mortality rate.
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Affiliation(s)
- Saif S. Al-Mudhaffar
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Ala Alwan
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Rafid Ouj
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Abdullah Mowaffaq
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Fahmi H. Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq,Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq,Correspondence to: Dr Fahmi H. Kakamad, College of Medicine, University of Sulaimani, 31 Madam Mitterrand Street, Sulaimani, Kurdistan 46000, Iraq
| | - Okba F. Ahmad
- Department of Surgery, Mosul Cardiac Center, Mosul 41001, Iraq
| | - Dana H. Mohammed-Saeed
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq,Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq,Sulaimani Center for Heart Disease, Sulaimani, Kurdistan 46000, Iraq
| | - Razhan K. Ali
- Department of Surgery, Shar Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Berun A. Abdalla
- Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | | | - Abdulwahid M. Salih
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq,Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
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Hlavicka J, Antonov K, Salem R, Hecker F, Marinos S, Radwan M, Emrich F, Van Linden A, Moritz A, Walther T, Holubec T. Long-Term Outcomes after Aortic Valve and Root Replacement in a Very High-Risk Population. J Cardiovasc Dev Dis 2022; 9:197. [PMID: 35735826 PMCID: PMC9225355 DOI: 10.3390/jcdd9060197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Aortic valve and root replacement (AVRR) is a standardised procedure to treat patients with aortic valve and root disease. In centres with a well-established aortic valve and root repair program (valve repairs and Ross operations), only patients with very complex conditions receive AVRR; this procedure uses a mechanical or biological composite valve graft (modified Bentall-de Bono procedure). The aim of the study was to evaluate the short- and long-term results after AVRR in a high-risk population with complex pathologies. Methods: Between 2005 and 2018, a total of 273 consecutive patients (mean age 64 ± 12.8 years; 23% female) received AVRR. The indication for surgery was an acute type A aortic dissection in 18%, infective endocarditis in 36% and other pathologies in 46% patients; 39% were redo procedures. The median EuroSCORE II was 11.65% (range 1.48-95.63%). Concomitant surgery was required in 157 patients (58%). Results: The follow-up extended to 5.2 years (range 0.1-15 years) and it was complete in 96% of the patients. The 30-day mortality was 17%. The overall estimated survival at 5 and 10 years was 65% ± 3% and 49% ± 4%, respectively. Univariate and multivariate logistic regression analyses revealed the following risk factors for survival: perioperative neurological dysfunction (OR 5.45), peripheral artery disease (OR 4.4) and re-exploration for bleeding (OR 3.37). Conclusions: AVRR can be performed with acceptable short- and long-term results in a sick patient population. The Bentall-De Bono procedure may be determined to be suitable for only elderly or high-risk patients. Any other patients should receive an AV repair or the Ross procedure in well-established centres.
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Affiliation(s)
- Jan Hlavicka
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Kiril Antonov
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Razan Salem
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Florian Hecker
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Spiros Marinos
- Division of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (S.M.); (M.R.)
| | - Medhat Radwan
- Division of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (S.M.); (M.R.)
| | - Fabian Emrich
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Anton Moritz
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60590 Frankfurt/Main, Germany; (J.H.); (K.A.); (R.S.); (F.H.); (F.E.); (A.V.L.); (A.M.); (T.W.)
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10
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Indriani S, Erriyanti S, Dewangga R, Adiarto S, Siddiq T, Dakota I. Late presentation of middle aortic syndrome complicated with severe aortic regurgitation; the role of endovascular intervention as a bridging for Bentall surgery. J Vasc Surg Cases Innov Tech 2022; 8:48-52. [PMID: 35097248 PMCID: PMC8783066 DOI: 10.1016/j.jvscit.2021.11.005] [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: 08/10/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Suci Indriani
- Correspondence: Suci Indriani, MD, Department of Cardiology and Vascular Medicine, Universitas Indonesia, Harapan Kita National Cardiovascular Center, Jl Letjen S Parman kav 87, Slipi, Jakarta 11420, Indonesia
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11
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PET imaging in cardiovascular infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Batta A, Panda P, Singh H, Sharma YP. Role of PET/CT scan in identifying late-onset graft infection following Bentall procedure. BMJ Case Rep 2021; 14:e243834. [PMID: 34544706 PMCID: PMC8454453 DOI: 10.1136/bcr-2021-243834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Akash Batta
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Panda
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Singh
- Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yash Paul Sharma
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Li H, Song Y, Liu X, Yu H, Huang X, Feng X, Dong N, Wu L. Short-term outcomes of a novel modified Bentall procedure in acute type A aortic dissection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:385-390. [PMID: 33616349 DOI: 10.23736/s0021-9509.21.11522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Bentall procedure is a common surgical treatment for aortic root replacement in acute type A aortic dissection (ATAAD) with some complications which affect postoperative efficacy. We innovatively modified the Bentall procedure and investigated its short-term efficacy. METHODS From March 2017 to March 2019, 77 cases with ATAAD in our department underwent total arch replacement and frozen elephant trunk technique following prior Bentall procedure. They were divided into three groups. In modified-Bentall group, 20 patients underwent a modified Bentall surgery. In Bentall-inclusion group, coronary ostia inclusion anastomosis and Cabrol shunt were performed in 32 patients. In Bentall-button group, coronary ostia button anastomosis was used to 25 cases. RESULTS No intraoperative deaths occurred in three groups. Operation time, CPB time, and aortic cross-clamp time in modified-Bentall group was longer than those in Bentall-inclusion group (P<0.05), but the number of RBC transfusion and postoperative drainage volume decreased compared with Bentall-button group (P<0.05). One patient with mesenteric malperfusion syndrome died after surgery in modified-Bentall group, 2 patients died in Bentall-inclusion group, and 1 patient died in Bentall-button group. No coronary anastomotic leak and vena cava-right atrium shunt signal occurred in modified-Bentall group, and there was no contrast extravasation and no pseudoaneurysm formation in the aortic root. The cardiac function of patients was grade I-II. CONCLUSIONS This novel modified procedure is feasible and can significantly reduce postoperative complications with satisfactory short-term efficacy in ATAAD.
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Affiliation(s)
- Huadong Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Song
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobin Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Yu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofan Huang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianqing Feng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Long Wu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China -
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14
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Fukui T, Ogasawara N, Hasegawa S. Dynamic kinking of right coronary artery after the button Bentall procedure. BMJ Case Rep 2021; 14:14/1/e239128. [PMID: 33509885 PMCID: PMC7845688 DOI: 10.1136/bcr-2020-239128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Postoperative coronary artery complications after Bentall procedures are well recognised but are rare and potentially fatal. There have been only five cases documenting percutaneous coronary intervention (PCI) for right coronary artery (RCA) involvements after button Bentall procedures. We describe a case of postoperative silent myocardial ischaemia in a 72-year-old man who underwent the button Bentall procedure for a right sinus of Valsalva aneurysm. On postoperative day 15, an RCA complication was incidentally detected by follow-up multidetector CT. Coronary angiography showed proximal RCA kinking, which was not an anastomosis but a native coronary artery. The patient underwent a successful PCI with drug-eluting stent implantation. We reviewed six cases consisting of this case and five previous cases treated with PCI. These cases enhance the recognition of potential RCA complications after the button Bentall procedure.
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Affiliation(s)
- Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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15
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Charchyan ER, Breshenkov DG, Belov YV. Results of Minimally Invasive Valve-Sparing Aortic Root Valve Surgery: Propensity Score Matching Analysis. ACTA ACUST UNITED AC 2020; 60:91-97. [PMID: 33155946 DOI: 10.18087/cardio.2020.7.n1098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
Aim Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM).Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6 %) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1-38 months (min-max) in the MS group and 42±21 (1-61 months (min-max) in the CS group.Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (р=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005).Conclusion The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients' stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.
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Affiliation(s)
- E R Charchyan
- Department of Reconstructive Cardiovascular Surgery, Petrovsky National Research Center of Surgery, Moscow
| | - D G Breshenkov
- Department of Reconstructive Cardiovascular Surgery, Petrovsky National Research Center of Surgery, Moscow
| | - Yu V Belov
- Department of Reconstructive Cardiovascular Surgery, Petrovsky National Research Center of Surgery, Moscow
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16
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Izzo D, Savino K, Castellani C, Sperandini L, Ragni T, Ambrosio G, Cavallini C. Post-traumatic Aortopulmonary Fistula after Bentall Procedure. J Cardiovasc Echogr 2020; 30:29-32. [PMID: 32766103 PMCID: PMC7307618 DOI: 10.4103/jcecho.jcecho_5_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
Pseudoaneurysm complicated by aortopulmonary fistula (APF) after a Bentall procedure is extremely rare but potentially fatal, so timely diagnosis and treatment are critical. We present a subacute case of a post-traumatic APF which has had initial aspecific symptoms and later an acute worsening heart failure with chest pain not responding to medical treatment and requiring emergency surgery.
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Affiliation(s)
- Daniela Izzo
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Ketty Savino
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | | | | | | | - Giuseppe Ambrosio
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
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17
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Persistent Coxiella burnetii cardiovascular infection on Bentall-De Bono prosthesis. Eur J Clin Microbiol Infect Dis 2020; 39:1003-1010. [DOI: 10.1007/s10096-020-03816-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/12/2020] [Indexed: 12/13/2022]
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18
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Salmasi MY, Theodoulou I, Iyer P, Al-Zubaidy M, Naqvi D, Snober M, Oo A, Athanasiou T. Comparing outcomes between valve-sparing root replacement and the Bentall procedure in proximal aortic aneurysms: systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:911-922. [DOI: 10.1093/icvts/ivz211] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 01/16/2023] Open
Abstract
AbstractIn aortic root aneurysms, the challenge of a valve-sparing aortic root replacement (VSRR) procedure is to ensure durable aortic valve function without reintervention. Although the Bentall procedure defers the durability of valve function to the prosthesis, short- and long-term complications tend to be higher. The aim of this study was to compare the outcomes of VSRR and Bentall procedures in patients with aortic root aneurysms. A systematic literature review was conducted using PubMed regarding the outcomes of the Bentall procedure compared with those of VSRR from the inception of the 2 procedures until July 2018. Studies with short- and long-term comparative data were included. An initial search yielded 9517 titles. Thirty-four studies were finally included for meta-analysis (all retrospective, non-randomized), comprising 7313 patients (2944 valve-sparing and 4369 Bentall procedures) with no evidence of publication bias. Operative mortality was found to be significantly lower in the VSRR group [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37–0.70; P < 0.001] despite overall higher cardiopulmonary bypass and aortic cross-clamp times. The 5-year survival rate was also more favourable in the VSRR group (OR 1.93 95% CI 1.15–3.23; P < 0.05). Significantly lower rates of cerebral thromboembolism (OR 0.668, 95% CI 0.477–0.935; P = 0.019) and heart block (OR 0.386, 95% CI 0.195–0.767; P = 0.007) were also found after VSRR. There was no significant difference in rates of reoperation between the groups at long-term follow-up (OR 1.32, 95% CI 0.75–2.33; P = 0.336). Meta-regression of patient and operative covariates yielded no influence on the main outcomes (P > 0.05). These findings suggest that VSRR is an appropriate and potentially better treatment option for a root aneurysm when the aortic valve is repairable.
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Affiliation(s)
| | - Iakovos Theodoulou
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Priyanka Iyer
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Danial Naqvi
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Aung Oo
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Thanos Athanasiou
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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19
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Serraino GF, Zanobini M, Beghi C, Maselli D, Bashir M, Mastroroberto P, Mariscalco G. Perspective. Reoperative Bentall: choice of conduits. Indian J Thorac Cardiovasc Surg 2019; 35:127-129. [PMID: 33061077 DOI: 10.1007/s12055-017-0607-x] [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: 09/01/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 11/24/2022] Open
Abstract
The Bentall procedure represents the gold standard in the treatment of patients requiring aortic root replacement. The most common indications for redo Bentall are structural degeneration or graft infection. Redo aortic root replacement can be performed with low perioperative morbidity and death. The choice of the best conduit is still up for debate but is mandatory to guarantee the best and most durable option for the patient. New options are available to reduce mortality in older or fragile patients and can modify the conduit choice.
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Affiliation(s)
- Giuseppe Filiberto Serraino
- Department of experimental and clinical medicine, University Magna Graecia of Catanzaro, Germaneto, Catanzaro Italy
| | - Marco Zanobini
- Cardiac Surgery Department, IRCCS Cardiologico Monzino, Milan, Italy
| | - Cesare Beghi
- Cardiac Surgical Department, Insubria University of Varese, Varese, Italy
| | - Daniele Maselli
- Cardiac Surgical Department, S.Anna Hospital, Catanzaro, Italy
| | - Mohamad Bashir
- Cardiothoracic Surgery, Barts Health NHS Trust, London, UK
| | - Pasquale Mastroroberto
- Department of experimental and clinical medicine, University Magna Graecia of Catanzaro, Germaneto, Catanzaro Italy
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital Groby Road, Leicester, UK
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20
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Liu Q, Jin J, Shao L, Weng S, Zhou J, Li F, Zhang W, Weng X, Gao Y. Late prosthetic valve endocarditis with Mycobacterium tuberculosis after the Bentall procedure. Ann Clin Microbiol Antimicrob 2019; 18:15. [PMID: 30922382 PMCID: PMC6437957 DOI: 10.1186/s12941-019-0314-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prosthetic valve endocarditis (PVE) is a rare but severe complication of valve replacement surgery, with an incidence rate of 0.3–1.2% per patient-year. At present, staphylococci are the predominant causative microorganism of PVE. Herein, we report a confirmed case of late PVE in a mechanical aortic valve caused by Mycobacterium tuberculosis. Case presentation A 32-year-old immunocompetent man with recurrent fever and 5-kg weight loss had a history of having undergone the Bentall procedure due to congenital heart disease. Nine years after the operation, he developed a paravalvular abscess in the mechanical aortic valve, presented with evidence of pulmonary tuberculosis on CT scan and was diagnosed with tuberculous endocarditis. This case report highlights a rare and non-negligible example of tuberculous endocarditis involving a mechanical valve. Conclusions Tuberculous PVE should be considered in patients with a history of valve replacement, recurrent fever, unexplained weight loss, pulmonary tuberculosis and meaningful valvular findings on echocardiogram.
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Affiliation(s)
- Qianqian Liu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jialin Jin
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Lingyun Shao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Shanshan Weng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Ju Zhou
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Feng Li
- Department of Cardiac Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.,Key Laboratory of Medical Molecular Virology, Ministry of Education and Health, Shanghai Medical College and Institutes of Biomedical Science, Fudan University, Shanghai, 200032, China
| | - Xinhua Weng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Yan Gao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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21
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18F-FDG-Labeled Autologous Leukocyte PET-CT in a Patient With Aortic Valve-Tube Graft Infection After Bentall Procedure. Clin Nucl Med 2019; 44:e161-e162. [PMID: 30672754 DOI: 10.1097/rlu.0000000000002447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infection of aortic valve-tube graft, although rare, is associated with high morbidity and mortality. Early identification of site and extent of infection is not only challenging but also crucial for adequate patient management and prognostication of disease. Combined clinical, laboratory investigation and imaging modalities assist in the identification of aortic valve graft infection. Molecular imaging techniques like PET/CT using F-FDG and F-FDG-labeled autologous leukocytes (LALs) have improved the sensitivity for detection of infection, resulting in better outcome for these patients. F-FDG-labeled autologous leukocyte PET/CT in our patient after Bentall procedure accurately localized the site and extent of infection.
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22
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Millar BC, de Camargo RA, Alavi A, Moore JE. PET/Computed Tomography Evaluation of Infection of the Heart. PET Clin 2019; 14:251-269. [PMID: 30826023 DOI: 10.1016/j.cpet.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.
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Affiliation(s)
- Beverley Cherie Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK.
| | - Raphael Abegão de Camargo
- Nuclear Medicine and Infectious Diseases, University of Sao Paulo Medical School (FMUSP), Sao Paulo, Sao Paulo, Brazil; Hospital Aristides Maltez, Avenida Dom João VI, n° 332, Serviço de Medicina Nuclear, 2° subssolo, Brotas, CEP: 40285-001, Salvador-BA, Brazil
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - John Edmund Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Corry Building, Belfast City Hospital, Lisburn Road, Belfast, Co. Antrim BT9 7AD, Northern Ireland, UK
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23
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Karangelis D, Tzertzemelis D, Demis AA, Economidou S, Panagiotou M. Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement. J Thorac Dis 2018; 10:6733-6741. [PMID: 30746218 DOI: 10.21037/jtd.2018.11.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We retrospectively reviewed our experience with the modified Bentall procedure and evaluated the short- and long-term results over a period of 18 years. Methods Between 1999 and 2017, 89 patients with a mean age of 57.3±13.9 years underwent the modified Bentall operation with a slight modification for the correction of aortic root disease. Results The operative mortality was 1.1% while the overall early mortality rate, defined as death within 30 days of initial hospitalization, was 2.2% (2/89). Logistic regression analysis revealed that increased Euroscore and aortic cross-clamp times were associated with greater likelihood for complications. The overall survival rates for the 89 patients (including deaths occurred at the initial hospitalization) were 93.0% (SE =3.0%) at 6 months, 93.0% (SE =3.0%) at 1 year, 89% (SE =5.0%) at 5 years and 73.0% (SE =5.0%) at 10, 15 and 18 years. Multiple Cox regression analysis for survival identified that increased aortic cross-clamp time, increased age, having a concomitant cardiac procedure and increased NYHA Class were associated with greater hazard. Left ventricular remodeling was assessed by means of echocardiography preoperatively and 1, 3, 6 and 12 months postoperatively. Conclusions According to our experience, the Bentall procedure is a safe procedure, provides optimal long-term survival and can still be regarded as the gold standard procedure for aortic root replacement.
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Affiliation(s)
- Dimos Karangelis
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Dimitrios Tzertzemelis
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Alexandros A Demis
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Stella Economidou
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Matthew Panagiotou
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
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24
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25
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Lee H, Cho YH, Sung K, Kim WS, Park KH, Jeong DS, Park PW, Lee YT. Clinical Outcomes of Root Reimplantation and Bentall Procedure: Propensity Score Matching Analysis. Ann Thorac Surg 2018; 106:539-547. [DOI: 10.1016/j.athoracsur.2018.02.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/29/2018] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
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26
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Delorme S, Ruchat P, Goy JJ. Percutaneous treatment of late complications of the Bentall procedure. Catheter Cardiovasc Interv 2018; 92:348-352. [PMID: 28296051 DOI: 10.1002/ccd.26994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 12/23/2016] [Accepted: 01/28/2017] [Indexed: 11/09/2022]
Abstract
Aortic pseudo-aneurysm following the Bentall procedure is a rare but potentially severe complication. Surgical reintervention represents a high risk. We report on two cases with different pseudo-aneurysm types which were successfully treated using two different percutaneous techniques. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- S Delorme
- Hôpital Cantonal Fribourg, Fribourg, Switzerland
| | - P Ruchat
- Clinique Cecil, Lausanne, Switzerland
| | - J J Goy
- Clinique Cecil, Lausanne, Switzerland
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27
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Mosbahi S, Stak D, Gravestock I, Burgstaller JM, Steurer J, Eckstein F, Ferrari E, Berdajs DA. A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection. Eur J Cardiothorac Surg 2018; 55:201-209. [DOI: 10.1093/ejcts/ezy266] [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: 04/24/2018] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Selim Mosbahi
- Department of General Surgery, County Hospital Freiburg, Freiburg, Switzerland
| | - Dushaj Stak
- Department of Cardiac Surgery, Triemli City Hospital, Zurich, Switzerland
| | - Isaac Gravestock
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Jakob M Burgstaller
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Johann Steurer
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Enrico Ferrari
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
- Department of Cardiac Surgery, Cardiocentro Ticcino, Lugano, Lugano, Switzerland
| | - Denis A Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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28
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Burgstaller JM, Held U, Mosbahi S, Stak D, Steurer J, Eckstein F, Berdajs DA. A systemic review and meta-analysis: long-term results of the Bentall versus the David procedure in patients with Marfan syndrome. Eur J Cardiothorac Surg 2018; 54:411-419. [DOI: 10.1093/ejcts/ezy158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/03/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jakob M Burgstaller
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Selim Mosbahi
- Department of General Surgery, County Hospital Freiburg, Freiburg im Breisgau, Switzerland
| | - Dushaj Stak
- Department of Cardiac Surgery, Triemli City Hospital, Zurich, Switzerland
| | - Johann Steurer
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis A Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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Sollini M, Berchiolli R, Delgado Bolton RC, Rossi A, Kirienko M, Boni R, Lazzeri E, Slart R, Erba PA. The "3M" Approach to Cardiovascular Infections: Multimodality, Multitracers, and Multidisciplinary. Semin Nucl Med 2018; 48:199-224. [PMID: 29626939 DOI: 10.1053/j.semnuclmed.2017.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management, as early treatment improves the prognosis. The diagnosis cannot be made on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. In this review, we describe data supporting the use of a Multimodality, Multitracer, and Multidisciplinary approach (the 3M approach) to cardiovascular infections. In particular, the role of white blood cell SPECT/CT and [18F]FDG PET/CT in most prevalent and clinically relevant cardiovascular infections will be discussed. In addition, the needs of advanced hybrid equipment, dedicated imaging acquisition protocols, specific expertise for image reading, and interpretation in this field are discussed, emphasizing the need for a specific reference framework within a Cardiovascular Multidisciplinary Team Approach to select the best test or combination of tests for each specific clinical situation.
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Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logronño, La Rioja, Spain
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Roberto Boni
- Nuclear Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Riemer Slart
- University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands; Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands.
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Arokiaraj MC, De Beule M, De Santis G. A novel sax-stent method in treatment of ascending aorta and aortic arch aneurysms evaluated by finite element simulations. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:39-45. [PMID: 28705446 DOI: 10.1016/j.jdmv.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/25/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVES A novel stent method to simplify treatment of proximal ascending aorta and aortic arch aneurysms was developed and investigated by finite element analysis. Therapy of ascending aortic and aortic arch aneurysms is difficult and challenging and is associated with various complications. METHODS A 55mm wide×120mm long stent was designed without the stent graft and the stent was deployed by an endovascular method in a virtual patient-specific aneurysm model. The stress-strain analysis and deployment characteristics were performed in a finite element analysis using the Abaqus software. RESULTS The stent, when embedded in the aortic wall, significantly reduced aortic wall stresses, while preserving the side coronary ostia and side branches in the aortic arch. When tissue growth was modeled computationally over the stent struts the wall stresses in aorta was reduced. This effect became more pronounced when increasing the thickness of the tissue growth. There were no abnormal stresses in the aorta, coronary ostium and at the origin of aortic branches. The stent reduced aneurysm expansion cause by hypertensive condition from 2mm without stenting to 1.3mm after stenting and embedding. CONCLUSION In summary, we uncovered a simple treatment method using a bare nitinol stent without stent graft in the treatment of the proximal aorta and aortic arch aneurysms, which could eventually replace the complex treatment methods for this disease.
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Affiliation(s)
- M C Arokiaraj
- Cardiology, Pondicherry institute of medical sciences, 605014 Pondicherry, India.
| | - M De Beule
- FEops nv, Technologiepark 3, IBiTech-bioMMeda, University of Ghent (UGent), 9000 Gent, Belgium
| | - G De Santis
- FEops nv, Technologiepark 3, IBiTech-bioMMeda, University of Ghent (UGent), 9000 Gent, Belgium
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Rashed A, Gombocz K, Vigh A, Alotti N. Total proximal anastomosis detachment after classical bentall procedure. Int J Surg Case Rep 2017; 37:173-176. [PMID: 28688312 PMCID: PMC5501880 DOI: 10.1016/j.ijscr.2017.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/05/2017] [Accepted: 06/11/2017] [Indexed: 11/28/2022] Open
Abstract
Total proximal anastomosis detachment after classical Bentall procedure is very rare and life-threatrning complication. Elongation of the left ventricle tract may serve a surgical solution to treat this complication. Surgeons performing the Bentall procedure must be familiar with all existing modifications.
Introduction Since its introduction in 1968, the Bentall procedure has been the primary surgical solution for aneurysms of the aortic root. However, many surgeons have reported serious procedural complications such as detachment of coronary ostia and pseudoaneurysm formation at anastomosis sites. Therefore, the Bentall procedure has undergone several modifications to eliminate those complications. Partial or total detachment of the proximal anastomosis is rarely reported. Presentation of case We report a total detachment of the proximal anastomosis after a Bentall operation with emphasis on the possible practical mechanisms, which might have led to the development of this very rare complication. The diagnosis was confirmed at a routine follow up examination and urgent surgery was performed. We also report our operative solution and review other possible surgical solutions that might be considered in this setting. Discussion The Bentall procedure and its modifications continue to be considered the gold standard for treating aneurysms involving the aortic root. Various modifications can serve as optimal solutions for procedure-related complications. Conclusion Surgeons performing the Bentall procedure must be familiar with all existing modifications because they are complementary to the original surgical procedure. In the absence of endocarditis left ventricle outflow tract elongation may be an acceptable surgical solution to deal with total detachment of the proximal anastomosis.
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Affiliation(s)
- Aref Rashed
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary.
| | - Karoly Gombocz
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary
| | - Andras Vigh
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary
| | - Nasri Alotti
- Department of Cardiac Surgery, Zala St. Raphael County Hospital, Zalaegerszeg, Hungary
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Machelart I, Greib C, Wirth G, Camou F, Issa N, Viallard JF, Pellegrin JL, Lazaro E. Graft infection after a Bentall procedure: A case series and systematic review of the literature. Diagn Microbiol Infect Dis 2017; 88:158-162. [PMID: 28330738 DOI: 10.1016/j.diagmicrobio.2017.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Bentall procedure is a cardiac surgery involving graft replacement of the aortic valve, aortic root and ascending aorta. Graft infection after Bentall's procedure (BGI) is infrequent but severe, and often difficult to diagnose and treat. PATIENTS AND METHODS A retrospective cohort study was performed using the Bordeaux endocarditis database of adult patients admitted to the Bordeaux University Medical Hospital for BGI between 2008 and 2014. Published case reports were identified in the literature. RESULTS We identified 10 BGI patients in the database and 13 in the literature. The majority of infections were late-onset (20/23) and occurred as a result of gram positive cocci bacterial infection (16/22). Detailed diagnoses of the described BGI were determined using echocardiography, computed tomography (CT) and positron emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not reported in any case. Prolonged antibiotic therapy and surgery were found to be the treatment of choice for BGI; however it was not always possible to perform a surgical intervention. Clinical relapses occurred even with a negative PET/CT, while PET/CT consistently positive for BGI occurred in the absence of clinical relapse. This suggests that the use of PET/CT for follow-up is questionable. CONCLUSION Diagnosis of BGI is difficult, due to the combination of clinical, biological, and radiological observations obtained through transesophageal echocardiography and CT. PET/CT is an alternative method to diagnosis BGI, but its impact on clinical management remains unclear. Current data suggests that if surgical replacement of the prosthesis is not possible, patients should be treated with prolonged antibiotic therapy.
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Affiliation(s)
- I Machelart
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - C Greib
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - G Wirth
- Department of Infectious Diseases, Pellegrin Hospital, Bordeaux, France
| | - F Camou
- Medical Intensive Care Unit, Saint André Hospital, Bordeaux, France
| | - N Issa
- Medical Intensive Care Unit, Saint André Hospital, Bordeaux, France
| | - J F Viallard
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - J L Pellegrin
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
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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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Salve GG, Javali SR, Dalvi BV, Krishnanaik S. Modified pediatric Bentall procedure: A novel technique in a rare case. Ann Pediatr Cardiol 2016; 9:244-7. [PMID: 27625523 PMCID: PMC5007934 DOI: 10.4103/0974-2069.189124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aneurysms of ascending aorta are rarely seen in pediatric age group. Only few cases with Marfans syndrome have been reported in the literature. Preferred treatment for these children has been the standard Bentall procedure (aortic root replacement with composite graft prosthesis). We report a 4-year-old male child with huge aneurysm of ascending aorta and aortic root dilation with severe aortic regurgitation, having phenotypic features of Loeys-Dietz syndrome type I. He underwent Bentall procedure with a novel modification (medial trap-door technique for coronary reimplantation). Short-term result of this procedure is encouraging and he is asymptomatic for the last 14 months of follow-up.
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Affiliation(s)
- Gananjay G Salve
- Department of Pediatric Cardiovascular and Thoracic Surgery, Seven Hills Hospital, Marol-Maroshi Road, Andheri East, Mumbai, India
| | - Satish R Javali
- Department of Pediatric Cardiovascular and Thoracic Surgery, Seven Hills Hospital, Marol-Maroshi Road, Andheri East, Mumbai, India
| | - Bharat V Dalvi
- Department of Pediatric Cardiovascular and Thoracic Surgery, Seven Hills Hospital, Marol-Maroshi Road, Andheri East, Mumbai, India
| | - Shivaprakash Krishnanaik
- Department of Pediatric Cardiovascular and Thoracic Surgery, Seven Hills Hospital, Marol-Maroshi Road, Andheri East, Mumbai, India
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Arzanauskaite M, Jankauskas A, Arzanauskiene R, Keleras E. Multimodality imaging in a late septic infection of aortic graft. BJR Case Rep 2016; 2:20150396. [PMID: 30363674 PMCID: PMC6180892 DOI: 10.1259/bjrcr.20150396] [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: 10/06/2015] [Revised: 11/19/2015] [Accepted: 12/19/2015] [Indexed: 12/03/2022] Open
Abstract
A 70-year-old diabetic female patient presented with fatigue, headaches, hallucinations and shivers following a history of sinusitis and ophthalmitis. She had an aortic surgery performed 7 years ago for a stenotic and regurgitant aortic valve with aneurysm of the ascending aorta. Work-up brain MRI revealed septic–embolic encephalitis. Multimodality cardiovascular imaging showed abnormal anterior wall of the ascending aortic graft with vegetation extending into the lumen. Blood culture was only positive for Aggregatibacter actinomycetemcomitans, an uncommon cause of infective endocarditis. During aortic surgery, the intraluminal vegetation with suppurated perigraft tissue was confirmed.
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Affiliation(s)
- Monika Arzanauskaite
- Radiology Department, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Antanas Jankauskas
- Radiology Department, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Reda Arzanauskiene
- Cardiology Department, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Evaldas Keleras
- Radiology Department, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
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Mookhoek A, Korteland NM, Arabkhani B, Di Centa I, Lansac E, Bekkers JA, Bogers AJ, Takkenberg JJ. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2016; 101:1684-9. [DOI: 10.1016/j.athoracsur.2015.10.090] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
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Benke K, Ágg B, Szabó L, Szilveszter B, Odler B, Pólos M, Cao C, Maurovich-Horvat P, Radovits T, Merkely B, Szabolcs Z. Bentall procedure: quarter century of clinical experiences of a single surgeon. J Cardiothorac Surg 2016; 11:19. [PMID: 26801237 PMCID: PMC4724135 DOI: 10.1186/s13019-016-0418-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background We retrospectively analyzed 25 years of experiences with the button Bentall procedure in patients with aortic root pathologies. Even though this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature, especially regarding single surgeon results. Methods Between 1988 and 2013, a total of 147 patients underwent the Bentall procedure by the same surgeon. Among them there were 62 patients with Marfan syndrome. At the time of the surgery the mean age was 46.5 ± 17.6 years. The impact of surgical experience on long-term survival was evaluated using a cumulative sum analysis chart. Results The Kaplan-Meier estimated overall survival rates for the 147 patients were 91.8 ± 2.3 %, 84.3 ± 3.1 %, 76.3 ± 4.9 % and 59.5 ± 10.7 % at 1,5,10 and 20 years, respectively. Multivariate Cox regression analysis identified EuroSCORE II over 3 % (OR 4.245, 95 % CI, 1.739–10.364, p = 0.002), acute indication (OR 2.942, 95 % CI, 1.158–7.480, p = 0.023), use of deep hypothermic circulatory arrest (OR 3.267, 95 % CI, 1.283–8.323, p = 0.013), chronic kidney disease (OR 6.865, 95 % CI, 1.339–35.189, p = 0.021) and early complication (OR 3.134, 95 % CI, 1.246–7.883, p = 0.015) as significant risk factors for the late overall death. The survival rate for freedom from early complication was 94.3 ± 2.2 %, 88.0 ± 3.3 %, 82.9 ± 4.7 % and 69.2 ± 8.4 % at 1,5,10 and 20 years. The main pathological findings of the aortic wall were cystic medial degeneration in 75 %, fibrosis in 6 %, atherosclerosis in 13 % and no pathological alteration in 6 % of the samples. The overall survival rate was significantly lower in patients operated in first 15 years compared to patients operated in the last decade (log-rank p = 0.011). Conclusion According to our long-term follow-up the Bentall operation provides an appropriate functional result by resolving the lesions of the ascending aorta. Based on our results, 25–30 operations done is necessary to gain such a level of confidence and experince to aquire better results on long-term survival. In addition, we discussed that there were no co-morbidities affecting on the survival of Marfan patients and prophylactic aortic root replacement ensures a longer survival among patients with Marfan syndrome.
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Affiliation(s)
- Kálmán Benke
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary. .,Hungarian Marfan Foundation, Budapest, Hungary.
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Lilla Szabó
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Odler
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Chun Cao
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
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Alani A, Kudaravalli P, Darabian S, Al-Ani A, Al-Juboori O, Budoff MJ. Serial contrast enhanced cardiac computed tomography to assess extensive peri-aortic abscess following Bentall procedure. Int J Cardiol 2014; 173:e7-8. [PMID: 24679690 DOI: 10.1016/j.ijcard.2014.03.055] [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: 03/06/2014] [Accepted: 03/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Anas Alani
- Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | | | - Sirous Darabian
- Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Aseel Al-Ani
- Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Omar Al-Juboori
- Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
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Girrbach F, Etz CD, Dohmen PM, von Aspern K, Luehr M, Borger MA, Misfeld M, Eifert S, Mohr FW. Longevity after mechanical aortic root replacement--do men live longer? J Thorac Cardiovasc Surg 2014; 148:2087-95. [PMID: 24768100 DOI: 10.1016/j.jtcvs.2014.03.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/12/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate whether longevity after mechanical aortic root replacement is influenced by the patient's gender. METHODS From February 1998 to June 2011, 476 patients (376 men, 100 women, mean age, 53±12 years; range, 18-88) underwent composite aortic root replacement. Of these patients, 398 (312 men) were included in the present analysis. The indications for root replacement were aortic valve dysfunction (mostly stenosis) and concomitant aneurysmal disease in 334 (83.9%), acute type A aortic dissection in 51 (12.8%), and infective endocarditis in 10 (2.5%). Other indications were technical or anatomic considerations (0.8%). RESULTS The women who presented for surgery were significantly older (men, 52±12 years vs women, 56±12 years; P=.01). However, no significant differences were found with regard to previous cardiac surgery (5.3%, 20 men [6.4%] vs 1 woman [1.2%]; P=.06), concomitant procedures (38%; 117 men [37.5%] vs 35 women [40.7%]; P=.62), or additive EuroSCORE (men, 5.1±2.2; women, 5.2±2.2; P=.55). The mean diameter of the ascending aorta was not significantly different between the 2 groups (men, 54±9 mm; women, 56±14 mm; P=.97). The median follow-up period was 7.4 years (range, 0-13; 2366 cumulative patient-years), with no significant difference in hospital mortality (men, 6.7% vs women, 10.5%; P=.25). Overall, men enjoyed significantly better longevity than did women. After 10 years, 73%±3% of the men and only 60%±6% of the women were alive (P=.03). Although no long-term survival benefit for either gender was found in an age-matched subgroup among young patients (P=.66), men experienced much more favorable longevity after 55 years of age (P=.04). Consequently, the longevity in men-but not in women-was equal to an age-matched normal population. CONCLUSIONS Overall, long-term survival after mechanical aortic root replacement was significantly better among men. However, comparing age-matched subgroups≤55 years old, no significantly different life expectancy was found after mechanical root replacement.
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Affiliation(s)
- Felix Girrbach
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
| | - Christian D Etz
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Konstantin von Aspern
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Maximilian Luehr
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Sandra Eifert
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Bae JM, Shin E, Heo DS. Safety of comprehensive aortic root and valve repair surgery: a retrospective outcomes research by national evidence-based health care collaborating agency, Korea. Korean Circ J 2012; 42:769-71. [PMID: 23236329 PMCID: PMC3518711 DOI: 10.4070/kcj.2012.42.11.769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/08/2012] [Accepted: 11/08/2012] [Indexed: 11/11/2022] Open
Abstract
Comprehensive aortic root and valve repair (CARVAR) is a recently introduced surgical technique for aortic valve disease. The National Evidence-based Health Care Collaborating Agency was offered by the ministry of Health and Welfare, Korea to perform a restrospective outcome analysis for this surgical procedure. The aims of this study were to evaluate the safety of patients who underwent CARVAR surgery and to provide a rationale for further prospective randomized study. During the period of March 2007 to November 2009, 397 patients received this procedure and enrolled in this study. Clinical events including major bleeding, endocarditis, re-operation and death were followed-up till March 2010 by medical records. During the follow-up periods, 1-year cumulative incidence of major bleeding, re-operation, endocarditis and death were 3.55, 5.65, 5.05 and 5.33%/year respectively. This study showed that the CARVAR technique is not beneficial, and is indeed even more harmful than conventional valve replacement surgery.
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Affiliation(s)
- Jong-Myon Bae
- National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Korea
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eunhee Shin
- National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Dae Seog Heo
- National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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