scholarly journals Early results after aortic annuloplasty with a complete external Dacron band

2021 ◽  
Author(s):  
John-Peder Escobar Kvitting ◽  
Jan Otto Beitnes ◽  
Runar Lundblad
Keyword(s):  
Aortic Regurgitation ◽  
Type Ii ◽  
Connective Tissue Disorders ◽  
Valve Repair ◽  
Aortic Valves ◽  
Late Mortality ◽  
Early Results ◽  
Cerebrovascular Events ◽  
Bicuspid Aortic Valves

Abstract Objective This study evaluates the early results of our initial experience with aortic annuloplasty using a complete external Dacron band in the setting of type Ic or type II aortic regurgitation (AR). Methods From May 2017 to August 2019, 16 patients (88% bicuspid aortic valves, no patients with connective tissue disorders) underwent aortic annuloplasty with an external complete Dacron band. Clinical and echocardiographic follow-up was 100% complete. Clinical and echocardiographic follow-up averaged 24.4 ± 9.3 and  15.1 ±  8.3 months, respectively. Results Mean cardiopulmonary and cross-clamp times were 105 ± 15 (72–127) and 86 ± 15 (51–113) min, respectively. Early and late mortality was 0%, with no incidents of endocarditis or cerebrovascular events during the follow-up. Two patients were re-operated during the follow-up, one due recurrent aortic regurgitation (12 months after the first operation) yielding a freedom from reoperation due to AR at 1 year and 3 years of 100% ± 0% and 93.3% ± 5.7%, respectively. Based on the latest echocardiogram, five patients had either none or trivial AR, six had mild AR, and three had mild-to-moderate AR. Conclusions The early clinical and echocardiographic results after using a complete external Dacron band are promising; however, more data and longer follow-up are needed to determine its role in annular management during aortic valve repair.

Aortic valve neocuspidization (the Ozaki procedure)

2021 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Autologous Pericardium ◽  
Bicuspid Aortic Valves

Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic valvulopathies of various entities (aortic stenosis, aortic regurgitation, aortic valve endocarditis) in both tricuspid and bicuspid aortic valves. Thus, aortic valve neocuspidization with fixed autologous pericardium represents a versatile alternative to complex aortic valve repair, with better hemodynamics compared to biological aortic valve replacement and without the need for lifelong anticoagulation, which characterizes mechanical aortic valve replacement. The authors meticulously describe all the technical steps of this highly reproducible, standardized procedure.

Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival

2021 ◽  
pp. 021849232110068
Author(s):  
Simon CY Chow ◽  
Jacky YK Ho ◽  
Micky WT Kwok ◽  
Takuya Fujikawa ◽  
Kevin Lim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Graft Patency ◽  
Complete Revascularization ◽  
Coronary Endarterectomy ◽  
Factors Affecting ◽  
Early Results ◽  
Cerebrovascular Events ◽  
Obtuse Marginal ◽  
One Year

Background Coronary endarterectomy aims to improve completeness of revascularization in patients with occluded coronary vessels. The benefits of coronary endarterectomy remain uncertain. The aim of this study was to evaluate short-term surgical outcomes and factors affecting graft patency post-coronary endarterectomy. Methods Between 2009 and 2019, 81 consecutive patients who had coronary endarterectomy done were evaluated for their perioperative and early results. A total of 36 patients with follow-up coronary studies were included in patency analysis. Mortality rates, major adverse cardiac and cerebrovascular events, and graft patency were outcomes of interest. Survival and risk factor analysis were performed with Kaplan–Meier and logistic regression analysis. Results The average age of the cohort was 61.9 ± 9.29 years. Complete revascularization rate was 95.4% post-coronary endarterectomy. The 30-day and 1-year mortality was 2.5 and 6.2%, respectively. One-year major adverse cardiac and cerebrovascular events rate was 11.1%. Periprocedural myocardial infarction rate was 7.4%. Three patients required repeat revascularization within a mean follow-up duration of 49.6 ± 36.5 months. Overall graft patency was 89.2% at 20.2 months and graft patency post-coronary endarterectomy was 85.4%. Arterial grafts showed 100% patency. Vein grafts to endarterectomized obtuse marginal branch had patency rates of 33.3%. Multiple endarterectomies were associated with worse one-year major adverse cardiac and cerebrovascular events (OR: 28.6 ± 1.16; P = 0.003). Conclusions Coronary endarterectomy facilitates completeness of revascularization and does not increase early mortality. Graft patency post-coronary endarterectomy on obtuse marginal artery was suboptimal. Judicious use of coronary endarterectomy should be practiced to balance the need of completeness of revascularization against the risk of myocardial infarction.

Are bicuspid aortic valves a limitation for aortic valve repair?

2011 ◽  
Author(s):  
Catalin C. Badiu ◽  
Sabine Bleiziffer ◽  
Walter B. Eichinger ◽  
Iva Zaimova ◽  
Andrea Hutter ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Bicuspid Aortic Valves

Intraoperative diagnosis of a quadricuspid aortic valve

2017 ◽  
Vol 26 (9) ◽  
pp. 704-706
Author(s):  
Hassan Tatari ◽  
Maziar Gholampour Dehaki ◽  
Gholamreza Omrani ◽  
Hafez Ghaheri ◽  
Alwaleed Al-Dairy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Incidental Finding ◽  
Aortic Valve Repair ◽  
Quadricuspid Aortic Valve ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Ventricular Septal Defect Closure

Quadricuspid aortic valve is a rare anomaly, and most patients require surgery for aortic regurgitation in the 5th or 6th decades of life; only a few cases of aortic valve repair in childhood have been reported. A 3-year-old boy was scheduled for ventricular septal defect closure and aortic valve repair. Quadricuspid aortic valve was an incidental finding at operation; it was repaired by joining the left anterior and right anterior cusps. At the 9-month follow-up, the patient had no more than mild aortic regurgitation. We emphasize the importance of detecting this anomaly, especially in children with aortic valve regurgitation.

Single leaflet reconstruction in paediatric aortic regurgitation using the Ozaki procedure

2021 ◽  
pp. 1-5
Author(s):  
Tao Shi ◽  
Zhan Gao ◽  
Shoujun Li ◽  
Zhongdong Hua
Keyword(s):  
Aortic Regurgitation ◽  
Surgical Results ◽  
Z Score ◽  
Valve Repair ◽  
Rank Tests ◽  
Short Term ◽  
Operative Death ◽  
Severe Aortic Regurgitation ◽  
Signed Rank

Abstract Objectives: Aortic valve repair in children is still a challenge. The aim of this study was to analyse the surgical results of children with aortic regurgitation who underwent single leaflet reconstruction using the Ozaki procedure in our medical centre. Methods: A retrospective study was conducted of nine children with aortic regurgitation who received single leaflet reconstruction from May 2017 to September 2019. Paired t-tests and Wilcoxon signed rank tests were used to compare the data at different time points. Results: The median surgical age was 4.7 (3.5, 6.4) years. Eight patients were pre-operatively diagnosed with severe aortic regurgitation, while one had moderate regurgitation. The left ventricles were significantly enlarged, with an average z-score of 3.8. Single leaflet reconstruction was carried out using glutaraldehyde-treated autologous pericardium under the standard Ozaki procedure. The median follow-up was 22 (14, 33) months. There was no post-operative death or re-intervention. One patient had moderate or more aortic regurgitation during the follow-up. The average degree of aortic regurgitation was mild, and the average z-score of the left ventricle decreased to −0.2 in the last follow-up. Conclusions: Single leaflet reconstruction using the Ozaki procedure was an effective surgical method for treating children with aortic regurgitation in our centre with satisfactory short-term results.

scholarly journals Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience

2020 ◽  
Vol 57 (6) ◽  
pp. 1137-1144
Author(s):  
Oliver K Jawitz ◽  
Vignesh Raman ◽  
Jatin Anand ◽  
Muath Bishawi ◽  
Soraya L Voigt ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transoesophageal Echocardiography ◽  
Aortic Disease ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Aortic Repair ◽  
Early Results

Abstract OBJECTIVES Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports ‘real-world’ early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/− root +/− arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS The median age was 58 years [interquartile range (IQR) 46–70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3–4+ in 37 (79%) patients. Forty-one (87%) patients had zero–trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5–20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10–13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

scholarly journals Mid-term durability of polytetrafluoroethylene patches in unicuspid aortic valve repair

2020 ◽  
Vol 31 (4) ◽  
pp. 555-558
Author(s):  
Irem Karliova ◽  
Tristan Ehrlich ◽  
Shunsuke Matsushima ◽  
Sebastian Ewen ◽  
Hans-Joachim Schäfers
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Severe Aortic Regurgitation ◽  
Aortic Replacement ◽  
Primary Indication ◽  
Ascending Aortic Replacement

Abstract OBJECTIVES Unicuspid aortic valve (UAV) morphology is a cause for aortic valve dysfunction in childhood or adolescence. Repair requires the use of patch material, and polytetrafluoroethylene (PTFE) has been proposed for this purpose because of lack of calcification. We reviewed our mid-term experience with PTFE for the repair of UAV to analyse the durability of this technique. METHODS Out of 21 patients with an UAV undergoing aortic valve repair for severe aortic regurgitation between 2014 and 2016, 11 patients (52%) were treated using PTFE patch material. Aortic regurgitation was present in all patients, the primary indication for surgery was regurgitation in 8, stenosis in 2 and aneurysm in 1. Symmetric bicuspidization of the UAV was performed in all. One patient required additional root remodelling for root dilatation, and another 3 tubular ascending aortic replacement. RESULTS No patient died in hospital or during follow-up. Seven patients (63.6%) required reoperation for progressive AR. Freedom from reoperation was 58% at 1 and 35% at 5 years postoperatively. At reoperation the PTFE patches were found dehisced from aortic wall and/or native cusp tissue. In 3 patients re-repair was performed; a stable result was achieved in 1. Two patients underwent valve replacement 3 months and 1 year postoperatively. The other 4 patients underwent valve replacement. CONCLUSIONS The repair of UAVs using PTFE patch is associated with poor durability, a more durable patch with better healing characteristics material is needed.

scholarly journals Aortic valve repair techniques: an early UK experience

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001107 ◽  
Author(s):  
Renata Greco ◽  
Mirko Muretti ◽  
Xy Jin ◽  
Mario Petrou
Keyword(s):  
Aortic Valve ◽  
Free Edge ◽  
Connective Tissue Disorder ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Early Results ◽  
The Uk ◽  
Repair Techniques

ObjectivesRetrospective review of early results with aortic valve repair (AVr) techniques.Methods61 consecutive patients underwent AVr surgery at our institutions between 2008 and 2018. 14 patients had a bicuspid aortic valve and 16 had a connective tissue disorder. In 48 patients, aortic regurgitation (AR) was secondary to an aortic root and/or ascending aneurysms, while in 13 it was due to primary cusp pathologies. 13 patients underwent isolated cusp repair, 19 sinotubular junction remodelling, 25 valve-sparing root replacement (VSRR) and 4 hemiroot replacement. Cusp repair techniques included: 18 free margin plication, 18 commissural re-suspensions, 3 raphe resections and 1 free-edge reinforcement. Subcommissural annuloplasty was performed in 25 patients (42%) with a dilated annulus (>28 mm).Results50 patients (82%) left the operating theatre with no AR, 8 with mild central and 3 with mild eccentric AR. In-hospital survival was 100%. Clinical follow-up was complete at 5.08±2.29 years and all patients were alive. Transthoracic echocardiographic follow-up was complete at 2.35±1.92 years and showed the presence of a moderate AR in 10 patients (18%) and severe AR in 2 patients (4%). One of these required re-do aortic valve replacement 6 years after VSRR. Freedom from re-operation at 8 years was 88.15%±1.51%.ConclusionGood early results are achievable following AVr with acceptable medium-term outcomes. AVr surgery continues to evolve, and concentrating the experience in specialist centres in the UK is recommended.

scholarly journals Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years

2020 ◽  
Vol 58 (1) ◽  
pp. 86-93 ◽  
Author(s):  
Erik Beckmann ◽  
Andreas Martens ◽  
Heike Krüger ◽  
Wilhelm Korte ◽  
Tim Kaufeld ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valves ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Initial Surgery ◽  
Bicuspid Aortic Valves ◽  
Valve Sparing

Abstract OBJECTIVES Aortic valve-sparing root replacement is an excellent treatment option for patients with intact tricuspid aortic valves. However, the durability in patients with bicuspid aortic valves is still a matter of debate. The aim of this study was to analyse the short- and long-term outcomes in patients with bicuspid aortic valves. METHODS Between July 1993 and October 2015, a total of 582 patients underwent the David I procedure, 50 of whom had a bicuspid aortic valve. In these patients, the mean age was 46 ± 13 years, and 80% (n = 40) were men. Follow-up was complete for 100% of patients and comprised a total of 552 patient-years with a mean follow-up time of 11 ± 5.2 years. RESULTS In addition to the David procedure, cusp plication was performed in 34% (n = 17) of patients and commissure repair in 8% (n = 4) of patients. There were no in-hospital deaths, and 1 patient (2%) had a perioperative stroke. The 1-, 5-, 10- and 20-year survival rates of patients after discharge were 98%, 94%, 88% and 84%, respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 20 years after initial surgery were 98%, 88%, 79% and 74%, respectively. Long-term freedom from reoperation was comparable to that of patients with tricuspid aortic valves (P = 0.2). CONCLUSIONS The David procedure has excellent short-term results in patients with a bicuspid aortic valve. In this study, the long-term durability of reimplanted bicuspid aortic valves was comparable to that of tricuspid valves. However, careful patient selection might have contributed to this, and further studies might be needed to definitely clarify this issue.

Are bicuspid aortic valves a limitation for aortic valve repair?

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
CC Badiu ◽  
S Bleiziffer ◽  
W Eichinger ◽  
I Zaimova ◽  
A Hutter ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Bicuspid Aortic Valves
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