scholarly journals Early and mid-term outcomes of modified aortic root repair for acute stanford type A aortic dissection

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L C Wang ◽  
Y X Liu ◽  
Y J Dun ◽  
X G Sun
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
False Lumen ◽  
Ascending Aorta ◽  
Aortic Sinus ◽  
Root Repair ◽  
Aorta Replacement ◽  
Aortic Root Repair ◽  
Ascending Aorta Replacement

Abstract Background Acute Stanford type A aortic dissection (ATAAD) is the most common catastrophic aortic event. Most ATAAD involves the aortic root which has many important anatomical structures such as aortic valve, so the proper treatment of dissected root can ensure a good prognosis for patients. However, there is still no consensus on root management strategies for ATAAD patients with aortic root involvement. Purpose This clinical study aimed to evaluate the therapeutic effect of modified aortic root repair in ATAAD. Methods From September 2017 to September 2020, Participants with root involvement of ATAAD were recruited who underwent modified aortic root repair as well as some additional procedure such as aortic valve junction suspension plasty based on the aortic sinus tear extent. During this novel procedure, the proximal anastomosis plane was at the level of the sinu-tubular junction and the false lumen below it was retained. We collected and analyzed the perioperative clinical data and follow-up imaging data of patients, and further evaluated the early and mid-term efficacy of this surgical approach. Results A total of 79 patients were enrolled, including 59 males and 20 females, the age was (52.4±11.3) years old (28–73 years), the diameter of aortic sinus was (38.6±4.1) mm, and the diameter of sinu-tubular junction was (41.8±4.8) mm. In this group, 75 patients (94.9%) received ascending aorta replacement, total arch replacement and frozen elephant trunk, 2 patients (2.5%) received ascending aorta replacement and hybrid total arch replacement, 2 patients (2.5%) received ascending aorta replacement and partial arch replacement. Cardiopulmonary bypass time was (197.2±58.6) min (118–455 min), blocking time was (132.6±38.9) min (73–323 min), circulatory arrest time was (10.3±7.0) min (0–27 min). There was no perioperative death, no paraplegia, one secondary thoracotomy, five renal failures needing hemodialysis treatment and two cerebral infarctions. Before patients discharged, aortic CTA showed that the residual false lumen in the sinus disappeared. And the diameter of the aortic sinus was (35.5±3.1) mm, the diameter of the junction of the aortic sinus was (30.0±3.0) mm. The patients were followed up for (18±12) months (3–35 months). There was one patient died during follow-up and no further surgical intervention at the root of the aorta. Follow-up aortic CTA showed no residual or new dissection in the aortic sinus and no significant difference in the diameters of aortic sinu-tubular junction (P=0.122) or aortic sinus (P=0.37) between postoperative period and follow-up period. Echocardiography showed that the structure and function of the aortic valve were normal. Conclusions The modified aortic root repair for ATAAD is relatively simple, easy to learn and safe in perioperative period. Early and mid-term follow-up image examination showed that the structure of aortic sinus returned to normal. The long-term clinical effect requires close attention. FUNDunding Acknowledgement Type of funding sources: None. Modified aortic root repair procedure Aortic root diameter change under CTA

scholarly journals Fate of mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement

2020 ◽  
Author(s):  
Alessandro Verzini ◽  
Marta Bargagna ◽  
Guido Ascione ◽  
Alessandra Sala ◽  
Davide Carino ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Term Survival ◽  
Kaplan Meier ◽  
Aortic Root Surgery ◽  
Increased Risk ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (± mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyze. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max 16.4). Kaplan Meier estimates were employed to analyze long-term survival. Cumulative incidence function for time to re-operation, recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63]. At follow-up there were no cases of aortic root surgery whereas 3 patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR>2+/4+ was 5.1±4.98% and of AS>moderate 6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a BAV did not significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.

scholarly journals Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement

2021 ◽  
Vol 13 (3) ◽  
pp. 1531-1542
Author(s):  
Yaojun Dun ◽  
Yi Shi ◽  
Hongwei Guo ◽  
Yanxiang Liu ◽  
Xiangyang Qian ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

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

2019 ◽  
Vol 29 (3) ◽  
pp. 339-343 ◽  
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.

scholarly journals Use of ASD closure device for the sealing of false lumen entry in the ascending aorta after dissection Type A surgical repair

2021 ◽  
Vol 14 (8) ◽  
pp. e242304
Author(s):  
Ivo Spasov Petrov ◽  
Zoran Iovan Stankov ◽  
Damyan Boychev Boychev
Keyword(s):  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Closure Device ◽  
Atrial Septal Defect Closure ◽  
Aorta Replacement ◽  
Type A Dissection ◽  
Asd Closure ◽  
Ascending Aorta Replacement

We present a case of a persistent false lumen after ascending aorta replacement due to Stanford Type A dissection treated by endovascular means. The main entry tear was occluded with an atrial septal defect closure device, sealing the false lumen. A total of five additional stents were implanted to centralise and secure the flow in the true lumen. CT scan at 6-month follow-up showed excellent results with a decreased total aortic diameter and thrombosed false lumen.

Early safety performance of a modified technique of aorta replacement with sinotubular stabilization

2021 ◽  
pp. 021849232110150
Author(s):  
Marco Moscarelli ◽  
Nicola Di Bari ◽  
Giuseppe Nasso ◽  
Khalil Fattouch ◽  
Thanos Athanasiou ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Safety Performance ◽  
Modified Technique ◽  
Sinotubular Junction ◽  
Aorta Replacement ◽  
Valve Sparing ◽  
Ascending Aorta Replacement

Background We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. Methods This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dilatation of the ascending aorta, normal sinuses of Valsalva dimension (<45 mm), with or without aortic annulus enlargement (>25 mm) and with various degree of aortic insufficiency (from grade 1 to 3). Results From April to October 2019, 20 patients were recruited from two centers; mean age was 66.9 ± 12.8 years, 13 were male; grade 1, 2 and 3 was present in 12, 2 and 6 patients, respectively. All patients underwent ascending aorta replacement with modified technique; an additional open subvalvular ring was used in 8 patients with aortic insufficiency ≥ 2; cusps repair was performed in 6 patients (5 plicating central stitches/1 shaving); concomitant coronary artery bypass grafting was performed in 10 patients. There was no 30-day mortality. One patient was re-explored for bleeding. All patients completed six-month follow-up; at the transthoracic echocardiography, there was no aortic insufficiency ≥ 1 except one patient with aortic insufficiency grade 1 who underwent ascending aorta replacement and subvalvular ring; no patients underwent reintervention. Conclusions This modified technique for ascending aorta replacement and sinotubular junction stabilization was safe. It could be associated with other aortic valve sparing techniques. However, such remodeling approach has to be validated in a larger cohort of patients with longer follow-up.

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