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Karadzha A, Sharifulin R, Khrushchev S, Afanasyev A, Sapegin A, Zheleznev S, Chernyavsky A, Bogachev-Prokophiev A. Minimally invasive versus conventional methods for aortic root surgery: Choosing the right approach. Asian Cardiovasc Thorac Ann 2024:2184923241259510. [PMID: 38831608 DOI: 10.1177/02184923241259510] [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: 06/05/2024]
Abstract
OBJECTIVE Partial upper sternotomy is preferred for isolated aortic valve replacement because of its optimal surgical visibility and favorable cosmetic outcomes; however, it is not commonly used for aortic root surgery, and the conventional median sternotomy is still the preferred method for most surgeons. We aimed to compare the safety and effectiveness of a minimally invasive approach (partial sternotomy [PS]) and conventional approach (median sternotomy [FS]) for aortic root surgery. METHODS Patients who underwent aortic root surgery at our hospital from 2016 to 2021 were retrospectively enrolled and divided into two groups. After propensity score matching, the conventional group included 156 patients and the minimally invasive group-57 patients. RESULTS Bicuspid aortic valves were observed in 63 (40.4%) and 33 (57.9%) patients in the FS and PS groups, respectively. Valve-sparing surgery was performed on 69 (44.2%) and 30 (52.6%) patients in the FS and PS groups, respectively. The minimally invasive approach was beneficial in terms of blood loss during the first 24 h after surgery (p = 0.029) and postoperative blood transfusion (p = 0.023). The survival rates and freedom from reoperation or severe aortic regurgitation after the David procedure were comparable between the standard and minimally invasive groups (p = 0.25; p = 0.66) at mid-term follow-up. CONCLUSIONS A minimally invasive approach for aortic root surgery can be safely performed as the standard approach. Partial upper sternotomy has the advantage of lower blood loss in the early postoperative period and does not negatively affect the results of valve-sparing root replacement.
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Affiliation(s)
- Anastasiia Karadzha
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Ravil Sharifulin
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | | | - Alexander Afanasyev
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Andrey Sapegin
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Sergey Zheleznev
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
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Helms F, Deniz E, Krüger H, Zubarevich A, Schmitto JD, Poyanmehr R, Hinteregger M, Martens A, Weymann A, Ruhparwar A, Schmack B, Popov AF. Minimally Invasive Approach for Replacement of the Ascending Aorta towards the Proximal Aortic Arch. J Clin Med 2024; 13:3274. [PMID: 38892985 PMCID: PMC11172865 DOI: 10.3390/jcm13113274] [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: 04/26/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: In recent years, minimally invasive approaches have been used with increasing frequency, even for more complex aortic procedures. However, evidence on the practicability and safety of expanding minimally invasive techniques from isolated operations of the ascending aorta towards more complex operations such as the hemiarch replacement is still scarce to date. Methods: A total of 86 patients undergoing elective surgical replacement of the ascending aorta with (n = 40) or without (n = 46) concomitant proximal aortic arch replacement between 2009 and 2023 were analyzed in a retrospective single-center analysis. Groups were compared regarding operation times, intra- and postoperative complications and long-term survival. Results: Operation times and ventilation times were significantly longer in the hemiarch replacement group. Despite this, no statistically significant differences between the two groups were observed for the duration of the ICU and hospital stay and postoperative complication rates. At ten-year follow-up, overall survival was 82.6% after isolated ascending aorta replacement and 86.3% after hemiarch replacement (p = 0.441). Conclusions: Expanding the indication for minimally invasive aortic surgery towards the proximal aortic arch resulted in comparable postoperative complication rates, length of hospital stay and overall long-term survival compared to the well-established minimally invasive isolated supracommissural ascending aorta replacement.
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Affiliation(s)
- Florian Helms
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Ezin Deniz
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Heike Krüger
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Alina Zubarevich
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jan Dieter Schmitto
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Reza Poyanmehr
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Hinteregger
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andreas Martens
- Clinic for Cardiac Surgery, University Clinic Oldenburg, 26129 Oldenburg, Germany
| | - Alexander Weymann
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Arjang Ruhparwar
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bastian Schmack
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Aron-Frederik Popov
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Staromłyński J, Kowalówka A, Gocoł R, Hudziak D, Żurawska M, Nowak W, Pasierski M, Sarnowski W, Smoczyński R, Bartczak M, Brączkowski J, Sadecka S, Drobiński D, Deja M, Szymański P, Suwalski P, Kowalewski M. Comparative Analysis of Long-Term Outcomes in Valve-Sparing Aortic Root Reimplantation: Full Sternotomy versus Mini-Sternotomy Approach. J Clin Med 2024; 13:2692. [PMID: 38731222 PMCID: PMC11084568 DOI: 10.3390/jcm13092692] [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: 02/29/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively (p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter (p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality (p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome.
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Affiliation(s)
- Jakub Staromłyński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Adam Kowalówka
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Radosław Gocoł
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Małgorzata Żurawska
- Clinical Cardiology Department, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.Ż.); (P.S.)
| | - Wojciech Nowak
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Michał Pasierski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Wojciech Sarnowski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Radosław Smoczyński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Maciej Bartczak
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Jakub Brączkowski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Sabina Sadecka
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Dominik Drobiński
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland; (R.G.); (D.H.); (M.D.)
- Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Szymański
- Clinical Cardiology Department, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.Ż.); (P.S.)
| | - Piotr Suwalski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
| | - Mariusz Kowalewski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.S.); (W.N.); (M.P.); (W.S.); (R.S.); (M.B.); (J.B.); (S.S.); (D.D.); (P.S.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 85-067 Bydgoszcz, Poland;
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 90127 Palermo, Italy
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Zhang H. Bicuspid aortic valve repair-current techniques, outcomes, challenges, and future perspectives. Front Cardiovasc Med 2024; 10:1295146. [PMID: 38235290 PMCID: PMC10791802 DOI: 10.3389/fcvm.2023.1295146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
Bicuspid aortic valve (BAV) is a common congenital heart condition that can lead to some valve-related complications, such as aortic stenosis and/or regurgitation, and is often associated with aortic root dilation. With the development and refinement of BAV repair techniques over the past three decades, surgical repair of BAV has emerged as an effective treatment option, offering symptomatic relief and improved outcomes. This review aims to summarize the current techniques, outcomes, and challenges of BAV repair, and to provide potential future perspectives in the field.
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Affiliation(s)
- Haiyu Zhang
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, United Kingdom
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Chen Y, Yu W, Jiang Y, Gao J, Xie D, Yu J, Li W, Liu Z, Xiong J. Effect of minimally invasive versus conventional aortic root replacement on transfusion and postoperative wound complications in patients: A meta-analysis. Int Wound J 2023; 21:e14396. [PMID: 37740672 PMCID: PMC10824600 DOI: 10.1111/iwj.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023] Open
Abstract
We examined whether small incision aortic root replacement could reduce the amount of blood transfusion during operation and the risk of postoperative complications. An extensive e-review of the 4 main databases (PubMed, Cochrane, Web of Science and EMBASE) was carried out to determine all the published trials by July 2023. The search terms used were associated with partial versus full sternotomy and aortic root. This analysis only included the study articles that compared partial and full sternotomy. After excluding articles based on titles or abstracts, selected full-text articles had reference lists searched for any potential further articles. We analysed a total of 2167 subjects from 10 comparable trials. The minimally invasive aortic root graft in breastbone decreased the duration of hospitalization (MD, -2.58; 95% CI, -3.15, -2.01, p < 0.0001) and intraoperative red blood cell transfusion (MD, -1.27; 95% CI, -2.34, -0.19, p = 0.02). However, there were no significant differences in wound infection (OR, 0.88; 95% CI, 0.16, 4.93, p = 0.88), re-exploration for bleeding (OR, 0.96; 95% CI, 0.60, 1.53, p = 0.86), intraoperative blood loss (MD, -259.19; 95% CI, -615.11, 96.73, p = 0.15) and operative time (MD, -7.39; 95% CI, -19.10, 4.32, p = 0.22); the results showed that the microsternotomy did not differ significantly from that of the routine approach. Small sternotomy may be an effective and safe substitute for the treatment of the aorta root. Nevertheless, the wide variety of data indicates that larger, well-designed studies are required to back up the current limited literature evidence showing a benefit in terms of complications like postoperative wound infections or the volume of intraoperative red blood cell transfusion.
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Affiliation(s)
- Yu Chen
- Department of Blood TransfusionFirst Affiliated Hospital of Gannan Medical UniversityGanzhouChina
| | - Wenbo Yu
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Yue Jiang
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Jianfeng Gao
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Dilin Xie
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Junjian Yu
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Wentong Li
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Ziyou Liu
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Jianxian Xiong
- Department of Cardiovascular SurgeryFirst Affiliated Hospital of Gannan Medical UniversityGanzhouChina
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Helms F, Schmack B, Weymann A, Hanke JS, Natanov R, Martens A, Ruhparwar A, Popov AF. Expanding the Minimally Invasive Approach towards the Ascending Aorta-A Practical Overview of the Currently Available Techniques. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1618. [PMID: 37763737 PMCID: PMC10534602 DOI: 10.3390/medicina59091618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Minimally invasive techniques have gained immense importance in cardiovascular surgery. While minimal access strategies for coronary and mitral valve surgery are already widely accepted and often used as standard approaches, the application of minimally invasive techniques is currently expanded towards more complex operations of the ascending aorta as well. In this new and developing field, various techniques have been established and reported ranging from upper hemisternotomy approaches, which allow even extensive operations of the ascending aorta to be performed through a minimally invasive access to sternal sparing thoracotomy strategies, which completely avoid sternal trauma during ascending aorta replacements. All of these techniques place high demands on patient selection, preoperative planning, and practical surgical implementation. Application of these strategies is currently limited to high-volume centers and highly experienced surgeons. This narrative review gives an overview of the currently available techniques with a special focus on the practical execution as well as the advantages and disadvantages of the currently available techniques. The first results demonstrate the practicability and safety of minimally invasive techniques for replacement of the ascending aorta in a well-selected patient population. With success and complication rates comparable to classic full sternotomy, the proof of concept for minimally invasive replacement of the ascending aorta is now achieved.
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Affiliation(s)
- Florian Helms
- Division for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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Holubec T, Al-Obaidi M, Walther T, Van Linden A. David procedure through an upper ministernotomy. Ann Cardiothorac Surg 2023; 12:380-382. [PMID: 37554709 PMCID: PMC10405342 DOI: 10.21037/acs-2022-avs2-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/28/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Mustafa Al-Obaidi
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
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Sromicki J, Van Hemelrijck M, Schmiady MO, Greutmann M, Bonassin Tempesta F, Mestres CA, Vogt PR, Carrel TP, Holubec T. Twenty-five year experience with aortic valve-sparing root replacement in a single teaching center. Front Cardiovasc Med 2023; 10:1104149. [PMID: 36970369 PMCID: PMC10036903 DOI: 10.3389/fcvm.2023.1104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectivesAortic valve-sparing root replacement (AVSRR) is a technically demanding procedure. In experienced centers it offers excellent short- and long-term results, making the procedure an attractive alternative for aortic root replacement especially in young patients. The aim of this study was to analyze long-term results of AVSRR using the David operation in our institution over the last 25 years.MethodsThis is a single-center retrospective analysis of outcomes of David operations performed in a teaching institution not running a large AVSRR-program. Pre-, intra- and postoperative data were collected from the institutional electronic medical record system. Follow-up data were collected through direct contact of the patients and their cardiologists/primary care physicians.ResultsBetween 02/1996 and 11/2019, 131 patients underwent David operation in our institution by a total of 17 different surgeons. Median age was 48 (33–59), 18% were female. Elective surgery was performed in 89% of the cases, 11% were operated as emergency in the setting of an acute aortic dissection. Connective tissue disease was present in 24% and 26% had a bicuspid aortic valve. At hospital admission 61% had aortic regurgitation grade ≥3, 12% were in functional NYHA-class ≥III. 30-day mortality was 2%, 97% of the patients were discharged with aortic regurgitation ≤2. In 10-year follow-up, 15 (12%) patients had to be re-operated because of root-related complications. Seven patients (47%) received a transcatheter aortic valve implantation, 8 (53%) required surgical replacement of the aortic valve or a Bentall-De Bono operation. Estimated reoperation-free survival at 5 and 10 years was 93.5% ± 2.4% and 87.0% ± 3.5%, respectively. Subgroup analysis showed no differences in reoperation-free survival for patients presenting with a bicuspid valve or preoperative aortic regurgitation ≥3. However a preoperative left ventricular end diastolic diameter of ≥5.5 cm was associated with worse outcome.ConclusionDavid operations can be performed with excellent perioperative and 10-year follow-up outcomes in centers not running large AVSRR-programs.
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Affiliation(s)
- Juri Sromicki
- Department of Cardiac Surgery, University Zurich and University Hospital Zurich, Zurich, Switzerland
- Correspondence: Juri Sromicki
| | - Mathias Van Hemelrijck
- Department of Cardiac Surgery, University Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Martin O. Schmiady
- Department of Cardiac Surgery, University Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Zurich and University Hospital Zurich, Zurich, Switzerland
| | | | - Carlos-A. Mestres
- Department of Cardiac Surgery, University Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Paul R. Vogt
- Department of Cardiac Surgery, University Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Thierry P. Carrel
- Department of Cardiac Surgery, University Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Tomáš Holubec
- Department of Cardiovascular Surgery, Goethe University Frankfurt and University Hospital Frankfurt, Frankfurt, Germany
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