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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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Deşer SB, Demirag MK, Yucel SM, Yildirim U, Güçlü MM, Polat M, Kolbakir F, Keceligil HT. Influence of Bentall Procedure on Left Ventricular Function. Braz J Cardiovasc Surg 2020; 35:34-40. [PMID: 32270958 PMCID: PMC7089754 DOI: 10.21470/1678-9741-2019-0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective To evaluate the influence of Bentall procedure on left ventricular function and condition on long-term follow-up. Methods Seventy-three consecutive patients who underwent an aortic root and ascending aorta replacement with composite valve button Bentall or flanged Bentall technique, from January 2007 to November 2018, were included in this retrospective study. Results Postoperative left ventricular ejection fraction significantly increased (52.14±11.38 vs. 56.79±11.36; P=0.041), left ventricular end-systolic diameter significantly reduced (38.25±9.31 mm vs. 34.17±9.15 mm; P=0.027), left ventricular end-diastolic diameter significantly reduced (56.42±9.72 mm vs. 51.58±9.03 mm; P=0.01), and left atrial diameter significantly reduced (45.33±12.77 mm vs. 39.25±12.41 mm; P=0.01), compared to preoperative values. Our long-term survival results are comparable with previous studies in which survival rates in 5 years and 10 years were 83.5% and 69.8%, respectively. In comparing patients according to their New York Heart Association (NYHA) functional class, it was shown that their postoperative functional capacity was improved during the follow-up period (2.1±0.56 vs. 1.2±0.42; P=0.001). Conclusion The Bentall procedure significantly improved the left ventricular systolic function and condition and decreased the left ventricular end-systolic and end-diastolic diameters and the left atrial diameter on long-term follow-up, based on the transthoracic echocardiography. Bentall procedure can be performed with acceptable mortality and morbidity rates on long-term follow-up.
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Affiliation(s)
- Serkan Burç Deşer
- Ondokuz Mayis University School of Medicine Department of Cardiovascular Surgery Samsun Turkey Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Mustafa Kemal Demirag
- Ondokuz Mayis University School of Medicine Department of Cardiovascular Surgery Samsun Turkey Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Semih Murat Yucel
- Ondokuz Mayis University School of Medicine Department of Cardiovascular Surgery Samsun Turkey Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ufuk Yildirim
- Ondokuz Mayis University School of Medicine Department of Cardiology Samsun Turkey Department of Cardiology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Murat Muzaffer Güçlü
- Ondokuz Mayis University School of Medicine Department of Cardiovascular Surgery Samsun Turkey Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Merve Polat
- Ondokuz Mayis University School of Medicine Department of Cardiovascular Surgery Samsun Turkey Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fersat Kolbakir
- Ondokuz Mayis University School of Medicine Department of Cardiovascular Surgery Samsun Turkey Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Hasan Tahsin Keceligil
- Ondokuz Mayis University School of Medicine Department of Cardiovascular Surgery Samsun Turkey Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Cevasco M, McGurk S, Yammine M, Sharma L, Ejiofor J, Norman A, Singh MN, Shekar P. Early and Midterm Outcomes of Valve-Sparing Aortic Root Replacement-Reimplantation Technique. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 6:113-117. [PMID: 30934106 PMCID: PMC6443388 DOI: 10.1055/s-0039-1683383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background
Valve-sparing aortic root replacement (VSARR) is an increasingly popular alternative to traditional aortic root replacement for aortic root aneurysm disease with a normal aortic valve. We evaluated the early and midterm outcomes of VSARR—reimplantation technique (VSARR-RT) done at a single institution over a decade.
Materials and Methods
We performed a retrospective study of all patients who underwent VSARR-RT between January 2004 and July 2014.
Results
A total of 85 patients underwent VSARR-RT. Median time to latest echocardiographic follow-up was 4 years (range: 15–72 months). Total observation time was 491 patient years. Mean age was 44.6 ± 14.3 years, and 13 (15%) were women. Thirty-nine (46%) patients had a connective tissue disorder and 6 (7%) had a bicuspid aortic valve. Thirty-three (39%) patients underwent concomitant procedures, including coronary artery bypass grafting (
n
= 9, 11%), mitral valve repair (
n
= 8, 9%), and aortic hemi-arch replacement (
n
= 7, 8%). There were no operative deaths or in-house mortality and no postoperative strokes. Kaplan-Meier analysis demonstrated survival of 99% (95% confidence interval [CI]: 97–100%) at 2 years and 98% (95% CI: 97–100%) at 8 years. Freedom from reoperation was 95.8% (95% CI: 91.2–100%) at 8 years. Freedom from endocarditis was 100% at 8 years. At the last echocardiographic follow-up, 95% of patients were free of severe aortic regurgitation (AR) and 82% free of moderate AR. Of the four patients who had severe AR, three underwent reoperations and received prosthetic valves and one is being clinically monitored.
Conclusion
This study reports early and midterm outcomes after VSARR-RT at our institution, including those patients who underwent a VSARR-RT procedure combined with other procedures. Further follow-up remains necessary to determine long-term outcomes.
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Affiliation(s)
- Marisa Cevasco
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maroun Yammine
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lokesh Sharma
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julius Ejiofor
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anthony Norman
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael N Singh
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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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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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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