scholarly journals Decade of Aortic Valve Sparing Reimplantation

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Klaus Kallenbach ◽  
Matthias Karck ◽  
Dorota Pak ◽  
Rolf Salcher ◽  
Nawid Khaladj ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Circulatory Arrest ◽  
Aortic Insufficiency ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Single Center Study ◽  
Valve Sparing ◽  
Ischemic Attack ◽  
Aortic Valve Reimplantation

Background— This single center study assesses the outcome of aortic valve sparing reimplantation (AVS) in 284 consecutive patients who were operated on for various indications during the last 11 years. Methods and Results— From July, 1993, to July, 2004, 284 patients underwent AVS. Mean age was 53±16 (range 8 to 84) years. Of the 284 patients, 184 were male (64.8%) and 54 (19%) experienced Marfan’s syndrome. Acute aortic dissection Stanford type A was present in 53 patients (19%) and a bicuspid aortic valve was present in 17 patients (6%). Concomitant arch replacement was necessary in 120 patients (42%). Additional procedures were performed in 66 patients (23.2%). Mean follow-up time was 41±32 (range 0 to 130) months. The 30-day mortality was 3.2% overall, 11.3% in emergency patients, and 1.3% in elective patients. Mean bypass time was 174±48 (range 90 to 440) minutes and aortic cross clamp time was 132±33 (range 64 to 283) minutes. In patients undergoing arch replacement, circulatory arrest was 25±17 (range 7 to 99) minutes. Rethoracotomy for bleeding was required in 4.6% of patients. During follow-up, there were 20 (7.3%) late deaths. Reoperation of the reconstructed valve was required in 15 patients (5.3%); underlying reasons were endocarditis (n=4) and aortic insufficiency (n=11) requiring aortic valve replacement. Average grade of aortic insufficiency increased significantly from 0.23±0.46 postoperatively to 0.34±0.59 at latest evaluation ( P =0.026). Two patients experienced a transient ischemic attack early postoperatively; no further thromboembolic complications were noticed. The majority of patients (96%) presented with a favorable exercise tolerance at last contact. Conclusions— The aortic valve reimplantation technique leads to excellent clinical outcome in patients with various pathologies. Lack of anticoagulation and favorable durability should encourage the extension of indications for this technique.

Ascending Aortic Replacement With Aortic Valve Reimplantation

Circulation ◽  
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.

scholarly journals Aortic root reimplantation procedure: a new milestone in aortic valve-sparing operations

2016 ◽  
Vol 20 (2) ◽  
pp. 49
Author(s):  
A. M. Chernyavskiy ◽  
D. S. Khvan ◽  
S. A. Alsov ◽  
D. A. Sirota ◽  
M. M. Lyashenko
Keyword(s):  
Aortic Valve ◽  
Conflict Of Interest ◽  
Aortic Root ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Long Term Follow Up ◽  
Valve Sparing ◽  
Reimplantation Procedure

<p><strong>Aim:</strong> Emphasis in this study was placed on clinical and functional assessment of a modified "Florida Sleeve" procedure during surgical correction of ascending aorta aneurysms with concomitant aortic insufficiency.<br /><strong>Methods:</strong> 32 patients with an aneurysm of the ascending aorta and aortic insufficiency underwent a modified "Florida Sleeve" procedure. The average follow-up was 17 (0-60) months. The average age of patients was 57±13 (23-73) years 56±13 years.<br /><strong>Results:</strong> The expected 4-year cumulative survival rate was 84.3%. Overall freedom from aortic insufficiency in the late period was 88.9%. Median aortic regurgitation was 1+ (1; 2). Long-term follow-up revealed no valve-associated complications.<br /><strong>Conclusion:</strong> The aortic root reimplantation procedure enables optimal correction of the existing lesions of the aortic root without performing aortic valve replacement and demonstrates stable clinical and functional outcomes in the long-term period.</p><p><strong>Key words:</strong> aortic aneurysm; aortic valve; valve-sparing operations.</p><p><strong>Funding</strong></p><p>The study had no sponsorship.</p><p><strong>Conflict of interest</strong></p><p>The authors declare no conflict of interest.</p>

scholarly journals Aortic valve reimplantation by using a Kuban Cuff technique in patients with ascending aorta aneurysm and aortic insufficiency

2016 ◽  
Vol 20 (2) ◽  
pp. 17
Author(s):  
S. Yu. Boldyrev ◽  
O. A. Rossokha ◽  
K. O. Barbukhatti ◽  
V. A, Porkhanov
Keyword(s):  
Aortic Valve ◽  
Circulatory Arrest ◽  
Postoperative Bleeding ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Vascular Prostheses ◽  
Aorta Aneurysm ◽  
Bentall Procedure ◽  
The Mean ◽  
Aortic Valve Reimplantation

<p><strong>Aim:</strong> This study was designed to evaluate the results of using a new method of aortic valve reimplantation named Kuban Cuff technique, where the key stage of surgery was to create new sinuses of Valsalva.<br /><strong>Methods:</strong> Analyzed over a period from 2011 to 2015 were the outcomes of treatment of 45 (37 males) patients with various anatomy of the aortic valve (tri/bicuspid ones) and initial pathologies: aneurysms of the root and the ascending aorta, dissection of the ascending aorta, insufficiency of the aortic valve. A detailed description of the surgical technique and the unique device to prepare a vascular graft for reimplantation is given. The mean age of patients was 56.5 years (46.5; 66.5), the average time of cardiopulmonary bypass was 193.6 min (128.9; 258.2), the aorta cross-clamping time was 142.6 min (104.5; 180.7), the circulatory arrest time was 28.1 min (13.1; 43.1).<br /><strong>Results:</strong> Hospital mortality was 2 (4.4%) patients. 3 (6.6%) patients underwent re-sternotomy because of postoperative bleeding. One patient had to undergo a redo (Bentall procedure) at 2 months after discharge from the hospital as a result of acute infective endocarditis of the aortic valve. All patients demonstrated a good function of the aortic valve with regurgitation of 0/1 grade. Prior to discharge, the aortic regurgitation grade was decreased from 2.83±0.44 before surgery to 0.62±0.7 after surgery. The mean follow-up time in 42 patients (93.3%) was 12.3 months (2.68; 21.98).<br /><strong>Conclusions:</strong> The Kuban Cuff technique fully recreates a close analogue of the natural aortic root, stabilizes the fibrous annulus of the aortic valve, minimizes the risk of bleeding from the anastomosis zone. The technique is simple and reproducible with any type of vascular prostheses and does not take much time.</p>

scholarly journals Initial results of aortic valve reconstruction using autologous pericardium (Ozaki's procedure)

2021 ◽  
Vol 33 ◽  
pp. 20-27
Author(s):  
Ngo Thanh Hung ◽  
Nguyen Cong Huu ◽  
Tran Thuy Nguyen ◽  
Nguyen Hoang Nam ◽  
Nguyen Ngoc Anh ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Area ◽  
Surgical Indications ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Autologous Pericardium ◽  
Valve Reconstruction ◽  
Initial Results ◽  
Valve Area

Introduction: This study report the clinical characteristics, surgical indications, surgical technique and initial outcomes of autologous pericardial aortic valve reconstruction using Ozaki’s procedure. Methods: The study included consecutive patients with isolated aortic valve disease who underwent Ozaki’s procedure between June 2017 and December 2019. Aortic valve cups were reconstructed by autologous pericardium using Ozaki’s procedure. Results: Seventy-two patients were enrolled (mean age 52.9 ± 13 years; 53 males) and consisted of 30 aortic stenosis cases, 20 aortic regurgitation cases, and 22 patients with a combination of both 72 patients, a bicuspid aortic valve was present in 20, and 7 patients had infective endocarditis. Surgery was performed via a full or partial sternotomy. The procedure was successful in 70 case, and two patients were converted to prosthetic valve replacement. The aortic cross-clamp time was 106.3 ± 13.8 minutes, cardiopulmonary bypass time was 136.7 ± 18.5 minutes. One patient died of cardiac tamponade in hospital, and two patients underwent reoperation due to bleeding and sternal infection, respectively,  were observed during the follow-up period of 30 days. 1-month postoperative echocardiography revealed that one patient had moderate aortic valve regurgitation, max trans-valvular pressure gradient was 16.1 ± 2.3 mmHg, and aortic valve area was 2.5 ± 0.2 cm ². Conclusions: Aortic valve reconstruction using autologous pericardium by Ozaki’s procedure was feasible, good hemodynamics, and can be applied to all lesions of the aortic valve.

scholarly journals Approaches to aortic valve preservation in patients with aortic root an-eurysms and aortic insufficiency: the David procedure

2009 ◽  
Vol 15 (2) ◽  
pp. 142-145
Author(s):  
V. Uspenskiy ◽  
I. V. Sukhova ◽  
M. L. Gordeev
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Aortic Insufficiency ◽  
Aortic Valve Insufficiency ◽  
Short Term ◽  
Aortic Root Aneurysm ◽  
Valve Insufficiency ◽  
The Common ◽  
Valve Sparing ◽  
Aortic Valve Reimplantation

Background. Aortic valve-sparing operations are one of the relatively new approaches for treatment of patients with aortic root aneurysm and aortic valve insufficiency, but nowadays the common treatment strategy is absent. Methods. We studied the short-term results of David I valve-sparing operations in 19 patients with aortic root aneurysms and aortic insufficiency. Results. There were no lethal cases observed. 3 patients had mild aortic regurgitation, the majority of patients had no or trace aortic insufficiency. The significant decrease of left ventricle sizes was shown. Conclusions. The David I technique of aortic valve reimplantation seems to be optimal in patients with aortic root aneurysm, aortic insufficiency and normal aortic cusps.

Abstract 4281: Does Preoperative Aortic Insufficiency Affect Outcome Following Aortic Valve Sparing Surgery?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent de Kerchove ◽  
Munir Boodhwani ◽  
David Glineur ◽  
Philippe Noirhomme ◽  
Gebrine El Khoury
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Systematic Approach ◽  
Cox Regression ◽  
Aortic Insufficiency ◽  
Rank Test ◽  
Term Outcome ◽  
Kaplan Meier ◽  
Valve Sparing

Aortic valve (AV) sparing surgery is an attractive option for the treatment of aortic root pathology. However, presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been associated with poorer outcome. We analyze the influence of preoperative AI severity and the need for cusp repair on the early and mid-term outcomes of AV sparing surgery. From 1996 to 2007, 134 consecutive patients underwent elective AV sparing surgery. (mean age − 52±16 years; 84% male). Significant preoperative AI (3+ or 4+) was present in 83 patients (62%) and 46 (34%) had a bicuspid valve. Root repair was performed with either the reimplantation (67%) or remodeling technique (33%). A systematic approach was used for intraoperative valve assessment and cusp repair was performed in 74 patients (55%). Clinical and echocardiographic follow-up was complete in 100% and 96% respectively at a mean follow-up time of 57 months (range: 12–147 months). Kaplan-Meier curves, log rank test, and Cox regression analyses were used. Hospital mortality was 0.7%. AV cusp repair was required in 53% of patients without significant AI and in 57% with significant AI (p=0.9). Cusp repair was required more frequently in bicuspid versus tricuspid valves (89% vs. 38%, p = 0.005). Overall survival at 5 and 8 years was 94±5% and 86±10% respectively. Freedom from recurrent AI (>2+) was similar with or without significant preoperative AI (90±10% vs. 86±10% at 5 years, p=0.5) and with or without cusp repair (87±11% vs. 89±10%, p=0.6; Figure 1). Freedom from AV reoperation at 5 years was similar with or without significant preoperative AI (94±6% vs. 89±8%, p=0.5) and with and without cusp repair (90±9% vs. 91±8%, p=0.8). With a systematic approach to valve assessment and cusp repair, AV sparing surgery for aortic root pathology has an acceptable early and mid-term outcome, irrespective of preoperative AI or need for cusp repair. Cusp repair is not predicted by presence of preoperative AI but is more frequent in bicuspid valves. Preoperative AI should not be considered a contra-indication for valve sparing surgery.

scholarly journals Use of Sutureless and Rapid Deployment Prostheses in Challenging Reoperations

2021 ◽  
Vol 8 (7) ◽  
pp. 74
Author(s):  
Igor Vendramin ◽  
Andrea Lechiancole ◽  
Daniela Piani ◽  
Gaetano Nucifora ◽  
Giovanni Benedetti ◽  
...  
Keyword(s):  
Aortic Valve ◽  
English Language ◽  
Aortic Cross Clamp ◽  
Prosthetic Valves ◽  
Stentless Bioprostheses ◽  
Valve In Valve ◽  
Valve Sparing ◽  
Transcatheter Valve ◽  
Rapid Deployment ◽  
Language Literature

Sutureless and rapid-deployment bioprostheses have been introduced as alternatives to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement. These devices have also been employed in extremely demanding surgical settings, as underlined in the present review. Searches on the PubMed and Medline databases aimed to identify, from the English-language literature, the reported cases where both sutureless and rapid-deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as bailout procedures. We have identified 25 patients for whom a sutureless or rapid-deployment prosthesis was used in complex redo procedures: 17 patients with a failing stentless bioprosthesis, 6 patients with a failing homograft, and 2 patients with the failure of a valve-sparing procedure. All patients survived reoperation and were reported to be alive 3 months to 4 years postoperatively. Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these settings, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions.

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.

scholarly journals Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience

2020 ◽  
Vol 57 (6) ◽  
pp. 1137-1144
Author(s):  
Oliver K Jawitz ◽  
Vignesh Raman ◽  
Jatin Anand ◽  
Muath Bishawi ◽  
Soraya L Voigt ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transoesophageal Echocardiography ◽  
Aortic Disease ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Aortic Repair ◽  
Early Results

Abstract OBJECTIVES Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports ‘real-world’ early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/− root +/− arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS The median age was 58 years [interquartile range (IQR) 46–70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3–4+ in 37 (79%) patients. Forty-one (87%) patients had zero–trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5–20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10–13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

Sign in / Sign up

Export Citation Format

Share Document