Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty

Abstract Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

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Aortic root remodeling operation: how do we tailor a tube graft?

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(02)03383-0 ◽

2002 ◽

Vol 73 (4) ◽

pp. 1117-1121 ◽

Cited By ~ 16

Author(s):

Kiyofumi Morishita ◽

Gen Murakami ◽

Tokuo Koshino ◽

Johji Fukada ◽

Yasuaki Fujisawa ◽

...

Keyword(s):

Aortic Root ◽

Aortic Root Remodeling

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Valve-Sparing Aortic Root Remodeling with Reinforcement of the Proximal Aortic Suture-Line

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2009.00849.x ◽

2009 ◽

Vol 24 (5) ◽

pp. 539-540

Author(s):

Domenico Calcaterra ◽

Lisardo Garcia ◽

Anthony Panos ◽

Tomas A. Salerno ◽

Marco Ricci

Keyword(s):

Aortic Root ◽

Suture Line ◽

Aortic Root Remodeling ◽

Valve Sparing

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Aortic root remodeling with extra-aortic annuloplasy

ASVIDE ◽

10.21037/asvide.2021.019 ◽

2021 ◽

Vol 8 ◽

pp. 019-019

Author(s):

Vincent Chauvette ◽

Marie-Ève Chamberland ◽

Laurence Lefebvre ◽

Ismail El-Hamamsy

Keyword(s):

Aortic Root ◽

Aortic Root Remodeling

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Abstract 18473: Rates and Risk Factors for Faster Aortic Root Growth in Pediatric Patients with Marfan Syndrome

Circulation ◽

10.1161/circ.130.suppl_2.18473 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Nitya Viswanathan ◽

Claudia Pedroza ◽

Shaine A Morris

Keyword(s):

Aortic Dissection ◽

Root Growth ◽

Marfan Syndrome ◽

Aortic Root ◽

Scoliosis Surgery ◽

Z Score ◽

Aortic Dilation ◽

Significant Difference ◽

Over Time ◽

Infantile Type

Background: Marfan Syndrome (MS) is associated with progressive aortic dilation and aortic dissection. Aortic dissection is typically preceded by aortic dilation. The goal of this study is to identify factors associated with faster rates of aortic root dilation in children with MS. Methods: Patients undergoing serial transthoracic echocardiograms (TTE) with MS were retrospectively identified from an institutional database. Those with >2 TTEs over 1 year apart and <21 years of age at first TTE were included. TTEs performed after aortic surgery were excluded. Using multivariable longitudinal linear regression analysis, sex, medication, presence of ectopia lentis, need for scoliosis surgery and infantile type of MS were evaluated for associations with rate of change in aortic root dimension and aortic root z-score over time. Results: Of 240 patients with MS, 146 were included. Median age at first TTE was 8.1 yrs (range 0-20.9 years), median length of follow up 6.5 years (range 1.0-20.1 years), and median number of studies was 8 (range 2-25). Sixty-one percent were male. Of the 146 patients, 123 (84%) were documented to be on medical therapy: 14 angiotensin receptor blocker (ARB), 66 B-Blocker (BB), 10 prior history of both, 5 BB+ARB, 27 were in the Pediatric Heart Network medication trial, 1 ACE inhibitor. Sixteen patients underwent root replacement surgery at a median age of 14.6 years (range 1.8-24). No patients had aortic dissection. Three patients had infantile MS. All of these patients underwent root replacement at 1.8, 2 and 4 years of age. Two underwent subsequent aortic root replacement at 6 and 8 years old. Mean rate of aortic root growth in the cohort was 0.12cm/year, and mean change in z-score was 0.02/year (p=0.23 compared to expected rate of no change). The only variable associated with faster root growth was infantile MS (1.3cm/year, p<0.001; z-score change of 6.9/year, p<0.001). There was no significant difference in the rate of aortic root growth between patients who received therapy with BB vs. ARB vs. BB+ARB. Conclusions: Children with MS did not have a significant change in aortic root z-score over time, and the only factor associated with more rapid aortic root growth was infantile type MS.

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Abstract 452: Longitudinal Visualization of Calcification Genesis and Growth in vivo : Novel Implications for Plaque Vulnerability

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.452 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Joshua D Hutcheson ◽

Claudia Goettsch ◽

Brett Pieper ◽

Tan Pham ◽

Jung Choi ◽

...

Keyword(s):

Cardiovascular Risk ◽

Aortic Root ◽

Atherogenic Diet ◽

Alizarin Red S ◽

Arterial Calcification ◽

Micro Computed Tomography ◽

Alizarin Red ◽

Histological Sections ◽

Over Time

Background: Clinical evidence links arterial calcification and cardiovascular risk. Fibrous cap microcalcifications can promote atherosclerotic plaque failure, and large calcifications can stabilize the plaque. Therefore, calcification morphology can determine cardiovascular morbidity, but temporal patterns of calcific mineral deposition and growth remain unknown. Results: Apolipoprotein E-deficient ( Apoe-/- ) mice on an atherogenic diet develop plaque calcification. Longitudinal studies were performed using two different fluorescent calcium tracers injected intravenously into Apoe-/- mice: calcein injection following 18 weeks of atherogenic diet (n=7) and alizarin red S injection into the same mice 1 (n=4) or 3 (n=3) weeks later. Imaging green (calcein) and red (alizarin red S) fluorescence provided snapshots of aortic calcification at 18, 19, and 21 weeks. Observations within histological sections revealed green microcalcifications at 18 weeks embedded within alizarin red stained larger calcifications that were formed by 19 weeks (a). These data demonstrate that microcalcifications present at the start of calcification become the core of the larger calcifications that develop over time. Serial histological sections from aortic root to arch (b) were digitally reconstructed into 3D volumes (c) to reveal total calcific burden and localization within the aortic wall (d). Total calcification volume increased at a significant rate of 6.0x10 6 μm 3 per week (R 2 =0.99, p=0.007) and progressed from aortic arch to aortic root over time (p<0.001). Observations closely match calcification morphologies found by micro-computed tomography of human coronary arteries. Conclusion: Temporal and spatial understanding arterial calcification growth is crucial given the link between mineral morphology and cardiovascular risk, and these techniques provide a method for testing therapeutic approaches to control calcification morphology over time in situ .

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Abstract 18662: Aortic Valve Orientation Angle is Associated With Aortic Morphology and Dissection Risk

Circulation ◽

10.1161/circ.130.suppl_2.18662 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ashutosh A Hardikar ◽

Andrea Iannaccone ◽

Thomas H Marwick

Keyword(s):

Aortic Root ◽

Orientation Angle ◽

Aortic Disease ◽

Asymmetry Index ◽

Aortic Annulus ◽

Shear Stresses ◽

Aortic Dilatation ◽

Left Wall ◽

Root Angle ◽

Aortic Root Enlargement

Introduction: Asymmetric aortic root enlargement may lead to unequal thinning of the aortic wall, differential shear stresses and dissection. We sought the association of aortic root morphology with aortoventricular angle (AVAng), LVOT-root angle (RootAng), root-aorta angle (AortAng) [Fig 1] and outcomes. Methods: Demographic, morphometric and epidemiological parameters were gathered in 100 patients with aortic disease over last 6 years and 50 age and sex matched controls undergoing aortic CT. Two observers measured AVAng, RootAng, AortAng between the proximal aorta, aortic annulus and LV outflow tract [Figure 1] and orthogonal diameters along the thoracic aorta, noting the type of arch and other pathologies. The root axis was taken by joining the midpoints of aortic annulus and sinotubular junction, and asymmetry index (AI) [Fig 1] was calculated as the ratio of the maximal distance between axis and right wall, and axis to left wall in coronal view. There were 22 aortic dissections in the study group, and follow up was 32.3 months. Results: AortAng was different between TAV and BAV, but AI and AVAng were similar. AortAng [P= 0.008], AI [P= 0.004] and AVAng [p=0.013] had the strongest correlation with aortic dilatation [>40 mm], and were different in the dissection group (Table). The AI correlated well with root dilatation while AortAng and AVAng correlated with ascending aortic dilatation. TAV had a diffuse pattern of aortic dilatation as compared to BAV. Conclusions: AVAng and RootAng correlate with aortic dilatation patterns, and also aortic dissection. The AVAng and AortAng may explain the differential shear stresses seen along the 2 curvatures in aortic pathologies.

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