Aortic Valve Morphology Determines the Presentation and Surgical Approach to Acute Type A Aortic Dissection

2014 ◽  
Vol 97 (6) ◽  
pp. 1991-1997 ◽  
Author(s):  
Bartosz Rylski ◽  
Nimesh D. Desai ◽  
Joseph E. Bavaria ◽  
Prashanth Vallabhajosyula ◽  
William Moser ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Surgical Approach ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Valve Morphology

Likelihood of Aortic Valve Preservation During Repair of Acute Type A Aortic Dissection

2020 ◽  
pp. 000313482094737
Author(s):  
Rosanne Thornhill ◽  
Wendy Shih ◽  
Marvin I. Amen ◽  
Mohan M. John ◽  
Rosario Floridia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Connective Tissue ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Connective Tissue Disorder ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Valve Morphology ◽  
Bicuspid Valve

Background We sought risk factors for replacement of the aortic valve with or without the root (AVR/root) in the setting of acute type A aortic dissection (ATAD) repair. Methods All ATAD repairs at our institution from January 2005 to June 2018 were reviewed. Baseline characteristics were recorded. For patients with aortic valve preservation, we documented the degree of aortic insufficiency (AI) postoperatively and on subsequent echocardiograms when available. Logistic regression was used to determine the association between preoperative characteristics and the odds ratio of AVR/root. Results 206 patients underwent repair of ATAD. Thirty-four were excluded for no documented AI grading. Forty-six underwent AVR/root during repair of the ATAD (including 40 root replacements). Of 126 that did not undergo AVR/root, 42 (33.33%) had follow-up echocardiograms at a median of 68 months postoperatively, 2 required reintervention for valve insufficiency. An increase in the degree of AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder was significantly associated with increased risk of AVR/root. Of 130 patients without connective tissue disorder, bicuspid aortic valve, aortic root aneurysm or intimal root tear, the rate of valve preservation was 65/65 (100%), 25/29 (86.2%), and 22/40 (55%) for those presenting with mild, moderate, and severe AI, respectively. Conclusion The degree of preoperative AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder significantly correlate with the failure of aortic valve preservation in patients with ATAD. The vast majority of tricuspid valves in patients without connective tissue disorder or aortic root pathology can be salvaged.

Likelihood of Aortic Valve Preservation During Repair of Acute Type A Aortic Dissection

2020 ◽  
Vol 86 (5) ◽  
pp. 415-421
Author(s):  
Rosanne Thornhill ◽  
Wendy Shih ◽  
Marvin I. Amen ◽  
Mohan M. John ◽  
Rosario Floridia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Connective Tissue ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Connective Tissue Disorder ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Valve Morphology ◽  
Bicuspid Valve

Background We sought risk factors for replacement of the aortic valve with or without the root (AVR/root) in the setting of acute type A aortic dissection (ATAD) repair. Methods All ATAD repairs at our institution from January 2005 to June 2018 were reviewed. Baseline characteristics were recorded. For patients with aortic valve preservation we documented the degree of aortic insufficiency (AI) postoperatively and on subsequent echocardiograms when available. Logistic regression was used to determine the association between preoperative characteristics and the odds ratio of AVR/root. Results A total of 206 patients underwent repair of ATAD. Thirty-four were excluded for no documented AI grading. Forty-six underwent AVR/root during repair of the ATAD (including 40 root replacements). Of 126 that did not undergo AVR/root, 42 (33.33%) had follow-up echocardiograms at a median of 68 months postoperatively and 2 required reintervention for valve insufficiency. Increase in degree of AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder were significantly associated with increased risk of AVR/root. Of 130 patients without connective tissue disorder, bicuspid aortic valve, aortic root aneurysm, or intimal root tear, the rate of valve preservation was 65/65 (100%), 25/29 (86.2%), and 22/40 (55%) for those presenting with mild, moderate, and severe AI, respectively. Discussion Degree of preoperative AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder significantly correlate with failure of aortic valve preservation in patients with ATAD. The vast majority of tricuspid valves in patients without connective tissue disorder or aortic root pathology can be salvaged.

scholarly journals 101 * AORTIC VALVE REPAIR IN ACUTE TYPE A AORTIC DISSECTION

2013 ◽  
Vol 17 (suppl 2) ◽  
pp. S93-S93
Author(s):  
R. Saczkowski ◽  
T. Malas ◽  
G. El Khoury ◽  
T. Mesana ◽  
M. Boodhwani
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Type A ◽  
Aortic Valve Repair ◽  
Acute Type ◽  
Valve Repair ◽  
Type A Aortic Dissection

scholarly journals Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

2021 ◽  
Author(s):  
Mahmoud Alhussaini ◽  
Eric Jeng ◽  
Tomas Martin ◽  
Amber Filion ◽  
Thomas Beaver ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Long Term Results ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Valve Sparing

Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

Aortic Valve Function at Medium-term Follow-up after Resuspension During Repair of Acute Type A Aortic Dissection. Royal Brompton and Harefield Hospitals, Experience

2019 ◽  
Vol 3 (sup1) ◽  
pp. 66-66
Author(s):  
Alessia Gambaro ◽  
Marco Morosin ◽  
Micheal Murphy ◽  
John Pepper ◽  
Jullien Gaer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Medium Term ◽  
Type A Aortic Dissection ◽  
Valve Function

Age-related presentation of acute type A aortic dissection

2018 ◽  
Vol 26 (9) ◽  
pp. 659-666 ◽  
Author(s):  
Pietro Giorgio Malvindi ◽  
Daniela Votano ◽  
Ahmed Ashoub ◽  
Amit Modi ◽  
Szabolcs Miskolczi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Connective Tissue ◽  
Aortic Dissection ◽  
Bicuspid Aortic Valve ◽  
Type A ◽  
Acute Type ◽  
Connective Tissue Disorders ◽  
Type A Aortic Dissection ◽  
Younger Patients ◽  
Intimal Tear

Background We evaluated the clinical and anatomic presentations of acute type A aortic dissection according to patient age. Methods We retrospectively reviewed 235 consecutive patients who underwent acute type A dissection repair between January 2000 and December 2014. The influence of age on anatomical and clinical presentation, surgical management in the entire cohort and also after exclusion of patients with known connective tissue disorders was assessed using logistic regression. Results Males presented with type A acute aortic dissection at a younger age than females. Acute onset with signs of myocardial ischemia, connective tissue disorders, or bicuspid aortic valve characterized the younger population. Extension to the coronary sinus(es) ( p = 0.0003), descending thoracic aorta ( p = 0.016), and abdominal aorta ( p = 0.029), and an intimal tear at the level of the aortic root ( p = 0.0017) correlated inversely with patient age. Similar findings were obtained after exclusion of patients with connective tissue disorders or a bicuspid aortic valve. Conclusions More frequent proximal and distal progression of the dissection flap occurs in younger patients with acute type A aortic dissection. Older age is associated with a lower probability of an intimal tear at the level of the sinus of Valsalva. These findings, associated with prognostic implications, account for the choice of more radical proximal procedures for repair of aortic dissection in younger patients.

scholarly journals Techniques of Proximal Root Reconstruction and Outcomes Following Repair of Acute Type A Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 33-41 ◽  
Author(s):  
Tyler Gunn ◽  
Sotiris Stamou ◽  
Nicholas Kouchoukos ◽  
Kevin Lobdell ◽  
Kamal Khabbaz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Operative Mortality ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Type A ◽  
Acute Type ◽  
Actuarial Survival ◽  
Type A Aortic Dissection ◽  
Replacement Procedure

Background: The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, aortic valve replacement (AVR), and a root replacement procedure. Methods: All patients who underwent acute Type A aortic dissection repair between January 2000 and October 2010 at four academic institutions were compiled from each institution’s Society of Thoracic Surgeons Database. This included 189 patients who underwent a concomitant aortic valve (AV) procedure; 111, 21, and 57 patients underwent AV resuspension, AVR, and the Bentall procedure, respectively. The median age of patients undergoing a root replacement procedure was significantly younger than the other two groups. Early clinical outcomes and 10-year actuarial survival rates were compared. Trends in outcomes and surgical techniques throughout the duration of the study were also analyzed. Results: The operative mortality rates were 17%, 29%, and 18%, for AV resuspension, AVR, and root replacement, respectively. Operative mortality (p = 0.459) was comparable between groups. Hemorrhage related re-exploration did not differ significantly between groups (p = 0.182); however, root replacement procedures tended to have decreased rates of bleeding when compared to AVR (p = 0.067). The 10-year actuarial survival rates for the AV resuspension, Bentall, and AVR groups were 72%, 56%, and 36%, respectively (log-rank p = 0.035). Conclusions: The 10-year actuarial survival was significantly lower in those receiving AVR compared to those receiving root replacement procedures or AV resuspension. Operative mortality was comparable between the three groups.

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