Sutureless aortic valve with supracoronary ascending aortic replacement as an alternative strategy for composite graft replacement in elderly patients

AbstractAortic valve disease is frequently associated with ascending aorta dilatation and can be treated either by separate replacement of the aortic valve and ascending aorta or by a composite valve graft. The type of surgery is depending on the exact location of the aortic dilatation and the concomitant valvular procedures required. The evidence for elective aortic surgery in elderly high-risk patients remains challenging and therefore alternative strategies could be warranted. We propose an alternative strategy for the treatment of ascending aortic aneurysm and aortic valve pathology with the use of a sutureless, collapsible, stent-mounted aortic valve prosthesis.

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Sutureless aortic valve prosthesis with supracoronary ascending aortic replacement as an alternative strategy for composite graft replacement in elderly high-risk patients.

10.22541/au.158949186.68466506 ◽

2020 ◽

Author(s):

Jules Olsthoorn ◽

Ka Yan Lam ◽

Ferdi Akca ◽

Erwin Tan

Keyword(s):

High Risk ◽

Aortic Valve ◽

Composite Graft ◽

Alternative Strategy ◽

Valve Prosthesis ◽

Graft Replacement ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Aortic Valve Prosthesis ◽

Risk Patients

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Redo aortic root repair in patients with infective prosthetic endocarditis using xenopericardial solutions

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz105 ◽

2019 ◽

Vol 29 (3) ◽

pp. 339-343 ◽

Cited By ~ 2

Author(s):

Stoyan Kondov ◽

Friedhelm Beyersdorf ◽

Bartosz Rylski ◽

Maximilian Kreibich ◽

Aleksandar Dimov ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Prosthetic Material ◽

Valve Prosthesis ◽

Short Term ◽

Root Repair ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Aortic Root Repair

Abstract OBJECTIVES We describe a conceptual approach involving the use of self-made xenopericardial grafts in combination with biological aortic valve prostheses and in addition using a xenopericardial tubes for aortic valve reimplantation in patients with infective prosthetic endocarditis after aortic root repair or supracoronary ascending aortic replacement. METHODS The cohort comprised 7 consecutive patients with proven prosthetic infection either after aortic root replacement (n = 5), the David operation (n = 1) or supracoronary ascending aortic replacement (n = 1). The strategy consists of complete removal of the infected prosthetic material and orthotopic reconstruction using a bovine pericardial patch sewn as a tube according to the required aortic diameter. RESULTS In case of valve replacement, Edwards Magna Ease (n = 4 patients) and Edwards Inspiris (n = 2 patients) were used inside the xenopericardial tube. Five patients also required hemiarch and 1 patient required complete aortic arch replacement. Median length of stay in the intensive care unit and on the regular ward thereafter was 11 (6.5–13.5) days and 26.0 (14.5–32.5) days, respectively. All patients were successfully discharged. Median follow-up time was 7.6 (±2.1) months. Currently, all patients are not on antibiotic therapy and free from any signs of persisting or recurring infection. At the short-term follow-up, no structural valve deterioration, paravalvular insufficiency or graft calcification was found. CONCLUSIONS Using a self-made xenopericardial graft in combination with a biological aortic valve prosthesis for a Bio-Bentall and using a xenopericardial tube for a Bio-David operation is a safe and reproducible strategy and presents an off-the-shelf alternative to homografts. The short-term results of this approach are excellent. Further studies are needed to confirm mid- and long-term durability in larger cohorts.

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Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-2-35-43 ◽

2016 ◽

Vol 20 (2) ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

M. L. Gordeev ◽

V. E. Uspenskiy ◽

G. I. Kim ◽

A. N. Ibragimov ◽

T. S. Shcherbinin ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Regurgitation ◽

Type A ◽

Aortic Insufficiency ◽

Ascending Aorta ◽

Type A Aortic Dissection ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Valve Sparing

Aim: The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery. Methods: From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement. Results: The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period. Conclusions: Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.<div class="well well-small">Funding</div> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies. Conflict of interestThe authors declare no conflict of interest.AcknowledgementThe authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology & Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.

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Thoracic endovascular aortic repair for an ascending aortic pseudoaneurysm

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320937142 ◽

2020 ◽

Vol 28 (6) ◽

pp. 330-332

Author(s):

Shintaro Takago ◽

Hiroki Kato ◽

Yoshitaka Yamamoto ◽

Kenji Iino ◽

Keiichi Kimura ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Side Branch ◽

Ascending Aorta ◽

Thoracic Endovascular Aortic Repair ◽

Postoperative Course ◽

Aortic Pseudoaneurysm ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Ascending Aortic Pseudoaneurysm

An 80-year-old woman underwent aortic valve replacement and ascending aortic replacement. Two years later, computed tomography revealed a pseudoaneurysm of the ascending aorta replaced with a prosthesis. The pseudoaneurysm arose from the stump of a side branch of the prosthesis. Endovascular treatment for the pseudoaneurysm was carried out using the aortic extension cuff of an infrarenal endovascular system. The postoperative course was uneventful.

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Bentall–De Bono procedure for aortic regurgitation and intraoperative rupture of moderately dilated ascending aorta: A case report

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-4-106-111 ◽

2021 ◽

Vol 25 (4) ◽

pp. 106

Author(s):

S. Yu. Boldyrev ◽

M. A. Marukyan ◽

V. N. Suslova ◽

K. O. Barbukhatti ◽

V. A. Porkhanov

Keyword(s):

Aortic Valve ◽

Histological Examination ◽

Conflict Of Interest ◽

Aortic Insufficiency ◽

Ascending Aorta ◽

Aortic Dilatation ◽

Aggressive Approach ◽

Aortic Replacement ◽

Valve Insufficiency ◽

Enhanced Computed Tomography

We herein present a clinical case of root and ascending aortic replacement in a patient with borderline enlargement of the ascending aorta and aortic valve insufficiency. A 65-year-old man was admitted to our clinic with signs of heart failure. Subsequent echocardiography and contrast-enhanced computed tomography revealed hemodynamically significant aortic insufficiency, as well as expansion of the ascending aorta. Diameter at the levels of the sinuses of Valsalva, sinotubular junction and tubular portion of the ascending aorta were 48, 47 and 44 mm, respectively. Based on the aforementioned data, indications for isolated aortic valve replacement were determined. Although the main portion of the surgery was unremarkable, at its final stage, a rupture of a section of the ascending aorta occurred. The results of intraoperative express histological examination of the enlarged aorta revealed connective tissue dysplasia and cystic median necrosis. Replacement of the ascending aorta was performed using the modified Bentall–De Bono technique. This case demonstrated that a borderline aortic dilatation of 40–50 mm at the ascending aorta was associated with pathological changes in its wall, which can cause fatal complications (rupture and dissection) and may require a more aggressive approach during surgical correction. Intraoperative express histological examination of the wall of the ascending aorta in ambiguous situations can help determine the scope of the intervention.Received 16 March 2021. Revised 14 September 2021. Accepted 15 September 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authors Literature review: S.Yu. Boldyrev, M.A. Marukyan Drafting the article: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova Critical revision of the article: S.Yu. Boldyrev, V.A. Porkhanov Surgical treatment: S.Yu. Boldyrev, M.A. Marukyan Final approval of the version to be published: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova, K.O. Barbukhatti, V.A. Porkhanov

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Subcoronary Implantation of a Stentless Valve in Patients with Aortic Aneurysms

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230801600503 ◽

2008 ◽

Vol 16 (5) ◽

pp. 355-360 ◽

Cited By ~ 1

Author(s):

Alexander John ◽

Basel Al-Hariri ◽

Juergen Ackemann ◽

Mohamed El-Mehsen ◽

Stefan Roethemeyer ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Disease ◽

Ascending Aorta ◽

Aortic Aneurysms ◽

Implantation Technique ◽

Cardiac Events ◽

Safe Alternative ◽

Aortic Replacement ◽

Adverse Cardiac Events ◽

Ascending Aortic Replacement

Experience with a new operation for patients with aortic valve disease and aneurysm or dissection of the ascending aorta is described. Twenty-four patients aged 66 87 years were operated on using a subcoronary implantation technique with a stentless aortic valve bioprosthesis and an extension using a vascular tube prosthesis. No major adverse cardiac events were observed in the postoperative period. This operation offers a safe alternative to the technically more demanding procedures of composite bioprosthetic ascending aortic replacement or full root replacement.

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Passing a Mechanical Aortic Valve With a Short Tip Dilator to Facilitate Aortic Arch Endovascular Branched Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211002506 ◽

2021 ◽

pp. 152660282110025

Author(s):

Nikolaos Konstantinou ◽

Sven Peterss ◽

Jan Stana ◽

Barbara Rantner ◽

Ramin Banafsche ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Stent Graft ◽

Mechanical Valve ◽

Valve Prosthesis ◽

Proper Position ◽

Mechanical Aortic Valve ◽

Aortic Replacement ◽

Custom Made ◽

Aortic Valve Prosthesis

Purpose To present a novel technique to successfully cross a mechanical aortic valve prosthesis. Technique A 55-year-old female patient with genetically verified Marfan syndrome presented with a 5-cm anastomotic aneurysm of the proximal aortic arch after previous ascending aortic replacement due to a type A aortic dissection in 2007. The patient also underwent mechanical aortic valve replacement in 1991. A 3-stage hybrid repair was planned. The first 2 steps included debranching of the supra-aortic vessels. In the third procedure, a custom-made double branched endovascular stent-graft with a short 35-mm introducer tip was implanted. The mechanical valve was passed with the tip of the dilator on the lateral site of the leaflet, without destructing the valve and with only mild symptoms of aortic insufficiency, as one leaflet continued to work. This allowed the implantation of the stent-graft directly distally of the coronary arteries. Postoperative computed tomography angiography showed no endoleaks and patent coronary and supra-aortic vessels. Conclusion Passing a mechanical aortic valve prosthesis at the proper position is feasible and allows adequate endovascular treatment in complex arch anatomy. However, caution should be taken during positioning of the endovascular graft as the tip may potentially damage the valve prosthesis.

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Endovascular Stent-Graft Repair of the Ascending Aorta: Assessment of a Specific Novel Stent-Graft Design in Phantom, Cadaveric, and Clinical Application

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02859-5 ◽

2021 ◽

Author(s):

Sven R. Hauck ◽

Alexander Kupferthaler ◽

Marlies Stelzmüller ◽

Wolf Eilenberg ◽

Marek Ehrlich ◽

...

Keyword(s):

Clinical Application ◽

Stent Graft ◽

Ascending Aorta ◽

The Novel ◽

Forward Movement ◽

Level Of Evidence ◽

Landing Zone ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Stent Graft Repair

Abstract Purpose To test a stent-graft specifically designed for the ascending aorta in phantom, cadaver, and clinical application, and to measure deployment accuracy to overcome limitations of existing devices. Methods A stent-graft has been designed with support wires to fixate the apices toward the inner curvature, thereby eliminating the forward movement of the proximal end which can happen with circumferential tip capture systems. The device was deployed in three aortic phantoms, and in four cadavers, deployment precision was measured. Subsequently, the device was implanted in a patient to exclude a pseudoaneurysm originating from the distal anastomosis after ascending aortic replacement. Results The stent-grafts were successfully deployed in all phantoms and cadavers. Deployment accuracy of the proximal end of the stent-graft was within 1 mm proximally and 14 mm distally to the intended landing zone on the inner curvature, and 2–8 mm distal to the intended landing zone on the outer curvature. In clinical application, the pseudoaneurysm could be successfully excluded without complications. Conclusion The novel stent-graft design promises accurate placement in the ascending aorta. The differential deployment of the apices at the inner and outer curvatures allows deployment perpendicular to the aortic axis. Level of Evidence No level of evidence.

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Abstract 15129: Outcomes Related to Age of Elective Surgery and Age of Dissection Within Genetically Triggered Aneurysm Conditions: The Gentac Experience

Circulation ◽

10.1161/circ.142.suppl_3.15129 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kathryn W Holmes ◽

Scott A Lemaire ◽

Richard B Devereux ◽

William J Ravekes ◽

Shaine A Morris ◽

...

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Elective Surgery ◽

Aortic Surgery ◽

Reference Population ◽

Ehlers Danlos Syndrome ◽

Aortic Replacement ◽

Fourth Decade ◽

Ascending Aortic Replacement ◽

Aortic Dissections

Introduction: The GenTAC Registry ( G enetically Triggered T horacic A ortic Aneurysms and Cardiovascular C onditions) followed patients with aortopathies over 8 years among 8 centers with the goal of evaluating cardiovascular outcomes. Methods: Enrollment initiated in 2007, and data were collected until 2015. We included diagnoses with >100 participants: Bicuspid aortic valve with aneurysm (BAV, n=879), Marfan syndrome (MFS, n=861), Familial thoracic aortic aneurysm or dissection (FTAAD, n=378), Other thoracic aortic aneurysm at < 50 years of age (Other<50, n=524), Turner syndrome (TS, n=298), Vascular Ehlers Danlos syndrome (VEDS, n=149), and Loeys-Dietz syndrome (LDS, n=121). We identified patients who underwent elective ascending aortic replacement, total unique dissections, and time to first dissection. With MFS as a reference population and adjusted for sex, endpoints were analyzed by a Firth penalized Cox-PH regression model to account for diagnosis groups with low event numbers. Results: LDS participants at a mean age of (24.5 ± 15.0y) were youngest at elective aortic surgery followed by MFS (32.3 ±12.3y), TS (37.6 ±13.6y), VEDS (35.0 ±SD 7.4y), Other<50 (40.3 ±SD 10.3y), FTAAD (42.9 ±14.2y), and BAV(49.4 ± 13.8 y). Dissections were reported in all diagnosis groups with a total of 472 unique dissections in 3210 patients (14%). Mean age at first dissection was in the third decade for LDS, TS, MFS, VEDS and in the fourth decade for BAV, FTAD, and Other<50. Adjusted hazard ratio for time to first dissection was higher in LDS, 1.77 (95%CI 1.14- 2.77), compared to MFS and other diagnosis groups (Figure 1). Conclusions: Reported aortic dissections were prominent in the GenTAC cohort. Despite elective surgery at a younger age, LDS patients had a higher hazard risk of dissection compared to other diagnosis groups.

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Ascending Aortic Replacement With Aortic Valve Reimplantation

Circulation ◽

10.1161/circ.100.suppl_2.ii-24 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Wolfgang Harringer ◽

Klaus Pethig ◽

Christian Hagl ◽

Gerd P. Meyer ◽

Axel Haverich

Keyword(s):

Aortic Valve ◽

Aortic Insufficiency ◽

Additional Patient ◽

Valve Repair ◽

Sinotubular Junction ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Ischemic Attack ◽

Aortic Valve Reimplantation

Background —Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft in patients with aortic root aneurysms corrects annular ectasia and dilatation of the sinotubular junction. The durability of this valve repair with respect to the increased mechanical stress on valve cusps has been discussed, is quite controversial, and is yet unknown. Methods and Results —From July 1993 to November 1998, a replacement of the ascending aorta with a repair of the aortic valve was performed in 75 patients (53 men and 22 women aged 50±19 years). Twenty-one patients (28%) had Marfan syndrome, and 11 patients (15%) had an aortic dissection, type Stanford A (6 acute, 5 chronic). In 17 patients (23%), concomitant replacement of the aortic arch was necessary. Clinical and echocardiographic follow-up was performed in 6- to 12-month intervals for a cumulative study period of 137 patient-years. No operative deaths occurred. Two patients (3%) died 5 and 20 months postoperatively. One additional patient experienced a transient ischemic attack within the first postoperative week. Three patients (4%) with progressive aortic insufficiency required aortic valve replacement after 9, 11, and 14 months. All other patients had no or mild aortic insufficiency. The repairs have now remained stable for ≤65 months (mean, 22±20 months). Other valve-related complications did not occur. Conclusions —Our results demonstrate that this type of aortic valve repair achieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace aortic insufficiency at initial echocardiography seems to be essential for durability.

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