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

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.

Download Full-text

A Modified Technique for Ascending Aorta Replacement With Sinotubular Junction Stabilization

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.03.121 ◽

2020 ◽

Vol 110 (4) ◽

pp. e335-e337

Author(s):

Marco Moscarelli ◽

Raffaele Bonifazi ◽

Giuseppe Nasso ◽

Nicola Di Bari ◽

Giuseppe Speziale

Keyword(s):

Ascending Aorta ◽

Modified Technique ◽

Sinotubular Junction ◽

Aorta Replacement ◽

Ascending Aorta Replacement

Download Full-text

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

10.22541/au.160901985.50675267/v1 ◽

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.

Download Full-text

Valve-Sparing Root and Total Arch Replacement for Cutis Laxa Aortopathy

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117698458 ◽

2017 ◽

Vol 10 (3) ◽

pp. 376-379

Author(s):

Anji T. Yetman ◽

James Hammel ◽

Jennifer N. Sanmann ◽

Lois J. Starr

Keyword(s):

Genetic Disorder ◽

Snp Array ◽

Aortic Aneurysms ◽

Cutis Laxa ◽

Cannulation Technique ◽

Aorta Replacement ◽

Valve Sparing ◽

Regions Of Homozygosity ◽

Ascending Aorta Replacement

Aortic aneurysms requiring surgery in early childhood are rare. Herein we describe the case of a three-year-old with massive aneurysmal aortic dilation secondary to the rare and often lethal genetic disorder, cutis laxa. Initial thoracic aortic aneurysm gene panel was negative. Parents of the child were not known to be consanguineous, but high-density SNP array revealed several regions of homozygosity. This prompted targeted sequence analysis that identified a novel homozygous missense mutation in the gene for cutis laxa, EFEMP2. The patient underwent aortic valve–sparing aortic root and ascending aorta replacement and total aortic arch replacement, with continuous, moderately hypothermic cardiopulmonary bypass, using a dual cannulation technique. He was discharged well on the third postoperative day and remains free of aneurysmal disease at two-year follow-up.

Download Full-text

Effect of Concomitant Coronary Artery Bypass Grafting on Outcomes of Ascending Aorta Replacement

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.03.070 ◽

2020 ◽

Vol 110 (6) ◽

pp. 2041-2046

Author(s):

N. Bryce Robinson ◽

Irbaz Hameed ◽

Ajita Naik ◽

M. Fatin Ishtiaq ◽

Mohamed Rahouma ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Ascending Aorta ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Aorta Replacement ◽

Ascending Aorta Replacement

Download Full-text

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

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-2-49-57 ◽

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

Aim: 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. Methods: 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. Results: 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. Conclusion: 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.Key words: aortic aneurysm; aortic valve; valve-sparing operations.FundingThe study had no sponsorship.Conflict of interestThe authors declare no conflict of interest.

Download Full-text

Partial Aortic Root Remodeling in Case of Ascending Aortic Aneurysms

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a754b6 ◽

2013 ◽

Vol 8 (4) ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Fabrizio Sansone ◽

Edoardo Zingarelli ◽

Fabrizio Ceresa ◽

Francesco Patanè

Keyword(s):

Aortic Root ◽

Pathological Process ◽

Ascending Aorta ◽

Aortic Aneurysms ◽

Bleeding Complications ◽

Sinotubular Junction ◽

Computed Tomographic ◽

Aortic Root Remodeling ◽

Aorta Replacement ◽

Ascending Aorta Replacement

Objective In degenerative ascending aortic aneurysms (AAAs), the pathological process may extend into the aortic root, causing aortic regurgitation (AR). As often one or two sinuses are involved, ascending aorta replacement should be associated with selected sinus replacement. Methods Thirty patients (21 men and 9 women; mean ± SD age, 70.0 ± 10.4) were operated on for ascending aorta and selected sinus replacement. All patients had degenerative AAA with sinotubular junction and partial root dilatation: one or two sinuses of Valsalva were involved. Mild to moderate-severe AR was present in all patients. The mean ± SD logistic EUROscore 1 was 15.4 ± 12.5. Twenty patients had ascending aorta replacement associated with noncoronary sinus replacement; 8 patients, associated with both right and noncoronary sinuses; 1 patient, associated with both left and noncoronary sinuses; and 1 patient, associated with left coronary sinus alone. Results There were no hospital or late deaths. No thromboembolic event or bleeding complications were reported. Postoperative echocardiography did not show significant AR, and computed tomographic scanning revealed a normal positioning of the vascular graft in the ascending aorta. Conclusions Remodeling of the sinotubular junction with selected sinus replacement in degenerative AAA is a valuable approach for aortic root remodeling, leading to a significant reduction of AR when the aortic leaflets are normal.

Download Full-text

Valve-sparing aneurysmal root/ascending aorta replacement in a 9-year-old patient with Marfan syndrome

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2018-1-61-65 ◽

2018 ◽

Vol 22 (1) ◽

pp. 61

Author(s):

V. N. Bogdanov ◽

I, V. Gladyshev ◽

E. F. Kharisova ◽

I. V. Harenko

Keyword(s):

Marfan Syndrome ◽

Tricuspid Valve ◽

Conflict Of Interest ◽

Clinical Case ◽

Surgical Repair ◽

Severe Form ◽

Ascending Aorta ◽

Aorta Replacement ◽

Valve Sparing ◽

Ascending Aorta Replacement

A clinical case report of a 9-year-old patient with a severe form of Marfan syndrome and significant enlargement of the aortic root and mitral/tricuspid valve failure is presented. The patient underwent successful one-stage surgical repair including reimplantation of the aortic valve using David procedure, mitral valve annuloplication and De Vega valvuloplasty of the tricuspid valve.Received 21 November 2017. Revised 19 February 2018. Accepted 27 February 2018.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions All authors contributed equally to the work.

Download Full-text

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

European Heart Journal ◽

10.1093/eurheartj/ehab724.2007 ◽

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

Download Full-text