Replacement of the Aortic Root and Ascending Aorta Using a Freestyle Valve and Woven Dacron Graft

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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Lupus Aortitis Leading to Aneurysmal Dilatation in the Aortic Root and Ascending Aorta

The Heart Surgery Forum ◽

10.1532/hsf98.20081123 ◽

2009 ◽

Vol 12 (2) ◽

pp. E105-E108 ◽

Cited By ~ 6

Author(s):

Derek R. Brinster ◽

John D. Grizzard ◽

Alok Dash

Keyword(s):

Aortic Root ◽

Ascending Aorta ◽

Aneurysmal Dilatation

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Radial self-navigated native magnetic resonance angiography in comparison to navigator-gated contrast-enhanced MRA of the entire thoracic aorta in an aortic patient collective

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00774-9 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Martina Correa Londono ◽

Nino Trussardi ◽

Verena C. Obmann ◽

Davide Piccini ◽

Michael Ith ◽

...

Keyword(s):

Magnetic Resonance ◽

Image Quality ◽

Magnetic Resonance Angiography ◽

Thoracic Aorta ◽

Aortic Root ◽

Aortic Disease ◽

Ascending Aorta ◽

Scan Time ◽

Contrast Enhanced

Abstract Background The native balanced steady state with free precession (bSSFP) magnetic resonance angiography (MRA) technique has been shown to provide high diagnostic image quality for thoracic aortic disease. This study compares a 3D radial respiratory self-navigated native MRA (native-SN-MRA) based on a bSSFP sequence with conventional Cartesian, 3D, contrast-enhanced MRA (CE-MRA) with navigator-gated respiration control for image quality of the entire thoracic aorta. Methods Thirty-one aortic native-SN-MRA were compared retrospectively (63.9 ± 10.3 years) to 61 CE-MRA (63.1 ± 11.7 years) serving as a reference standard. Image quality was evaluated at the aortic root/ascending aorta, aortic arch and descending aorta. Scan time was recorded. In 10 patients with both MRA sequences, aortic pathologies were evaluated and normal and pathologic aortic diameters were measured. The influence of artifacts on image quality was analyzed. Results Compared to the overall image quality of CE-MRA, the overall image quality of native-SN-MRA was superior for all segments analyzed (aortic root/ascending, p < 0.001; arch, p < 0.001, and descending, p = 0.005). Regarding artifacts, the image quality of native-SN-MRA remained superior at the aortic root/ascending aorta and aortic arch before and after correction for confounders of surgical material (i.e., susceptibility-related artifacts) (p = 0.008 both) suggesting a benefit in terms of motion artifacts. Native-SN-MRA showed a trend towards superior intraindividual image quality, but without statistical significance. Intraindividually, the sensitivity and specificity for the detection of aortic disease were 100% for native-SN-MRA. Aortic diameters did not show a significant difference (p = 0.899). The scan time of the native-SN-MRA was significantly reduced, with a mean of 05:56 ± 01:32 min vs. 08:51 ± 02:57 min in the CE-MRA (p < 0.001). Conclusions Superior image quality of the entire thoracic aorta, also regarding artifacts, can be achieved with native-SN-MRA, especially in motion prone segments, in addition to a shorter acquisition time.

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Geometric changes in aortic root replacement using Freestyle prosthesis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01583-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Anja Osswald ◽

Alina Zubarevich ◽

Arian Arjomandi Rad ◽

Robert Vardanyan ◽

Konstantin Zhigalov ◽

...

Keyword(s):

Aortic Root ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Aortic Annulus ◽

Strongly Correlated ◽

Root Volume ◽

Concomitant Surgery ◽

Valve Size ◽

Operative Planning ◽

Geometric Changes

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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Technique of Aortic Root Reconstruction Using a New Model of Dacron Graft With Prefabricated Coronary Branches

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000111 ◽

2014 ◽

Vol 9 (6) ◽

pp. 451-453

Author(s):

Domenico Calcaterra ◽

Robert S. Farivar ◽

Kalpaj R. Parekh ◽

Mohammad Bashir ◽

Karam Karam ◽

...

Keyword(s):

Aortic Root ◽

Dacron Graft ◽

New Model

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M26 How Does the Histology of the Aortic Root and Ascending Aorta Affect Aortic Aneurysm Progression and Surgical Repair?

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.03.035 ◽

2021 ◽

Vol 30 ◽

pp. S11

Author(s):

T. Surman ◽

D. O'Rourke ◽

J. Finnie ◽

K. Reynolds ◽

J. Edwards ◽

...

Keyword(s):

Aortic Aneurysm ◽

Aortic Root ◽

Surgical Repair ◽

Ascending Aorta

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Ascending aorta graft pseudoaneurysm and aortobronchial fistula caused by a fractured sternal wire: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01737-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ahmad Ali Amirghofran ◽

Elahe Nirooei ◽

Mohammad Ali Ostovan

Keyword(s):

Unusual Case ◽

Preventive Measures ◽

Prosthetic Graft ◽

Ascending Aorta ◽

Dacron Graft ◽

Thoracoabdominal Aorta ◽

Case Presentation ◽

Pseudoaneurysm Formation ◽

Aortobronchial Fistula ◽

History Of

Abstract Background Pseudoaneurysm of ascending aorta is a rare but serious complication of cardiovascular surgeries and it infrequently occurs in the normal prosthetic graft materials. We share our experience with an unusual case of ascending aorta Dacron graft pseudoaneurysm caused by a fractured sternal wire. Case presentation A 34-year-old man, known case of Marfan syndrome, with history of two prior aortic surgeries for aneurysm of ascending aorta, arch and thoracoabdominal aorta, presented with hemoptysis. The hemoptysis originated from an aortobronchial fistula secondary to a huge ascending aorta Dacron graft pseudoaneurysm. The graft erosion and subsequent pseudoaneurysm was caused by a fractured sternal wire. Surgical repair of the pseudoaneurysm was performed successfully and a Gore-tex patch was placed behind the sternum over the graft to prevent further direct contact of the wire and the graft. Conclusion Sternal wires can damage the adjacent vascular grafts and lead to fatal complications such as pseudoaneurysm formation. Thus, preventive measures such as using sternal bands and placing a covering layer between the sternal wires and aortic grafts are recommended in patients with dilated or replaced ascending aorta.

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Ascending aorta and aortic root replacement in an infant: a case report

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-3-83-93 ◽

2021 ◽

Vol 25 (3) ◽

pp. 83

Author(s):

V. A. Mironenko ◽

V. S. Rasumovsky ◽

A. A. Svobodov ◽

S. V. Rychin

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Aortic Root ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Vascular Prosthesis ◽

Ascending Aorta ◽

Left Common Carotid Artery ◽

Brachiocephalic Trunk

We herein report the first clinical case of prosthetic replacement of the ascending aorta and aortic arch to repair a giant aneurysm in a 7-month-old child. The ascending aorta and arch replacement to the level of left subclavian artery was performed using a no. 16 Polymaille prosthesis, the brachiocephalic trunk was reimplanted into the vascular prosthesis and the kinked section of the left common carotid artery was removed, followed by reimplanting the left common carotid artery into the left subclavian artery. First, proximal anastomosis with the vascular prosthesis was created using a no. 16 Polymaille prosthesis and the vascular suture was strengthened with a Teflon strip. During circulatory arrest, the aortic arch was crossed between the orifice of the left common carotid artery and left subclavian artery, with the cut extended to the isthmus region along the small curvature of the arch. The brachiocephalic trunk was aligned and brought down, with subsequent implantation into the ascending aorta prosthesis 2 cm below the initial fixation point. In the final stage, the kinked section of the left common carotid artery was resected and the aligned left carotid artery was directly reimplanted into the left subclavian artery using end-to-side anastomosis. The patient developed tracheobronchitis and moderate heart failure during the postoperative period. The duration of mechanical ventilation was 16 hours. Infusion and antibacterial therapy were discontinued on postoperative day 8. On postoperative day 13, the patient was discharged and referred to the outpatient centre for further treatment and rehabilitation. A sufficiently large-sized prosthesis allows for further development in paediatric patients. This is facilitated by the preservation of the native aortic root with restored valve function and the formation of a bevelled distal anastomosis with a small unchanged aortic section in the isthmus region, which maintains growth potential. This first reported case of an infant demonstrates the possibility of combination interventions on the aortic arch and brachiocephalic artery during the first year of life.Received 30 January 2021. Revised 24 March 2021. Accepted 29 March 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors: The authors contributed equally to this article.

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