Early and long-term results of aortic valve sparing aortic root reimplantation surgery for bicuspid and tricuspid aortic valves

Introduction: To evaluate early and long-term clinical outcomes following aortic valve sparing aortic root reimplantation surgery in patients with leaking bicuspid and tricuspid aortic valves. Methods: The study consisted of 92 consecutive adult patients (tricuspid aortic valve group = 63 and bicuspid aortic valve group = 29) who underwent aortic valve sparing aortic root reimplantation surgery with or without aortic cusp repair for dilatation of the aortic root and/or aortic valve regurgitation at our institution from April 2004 to October 2016. Clinical outcomes were investigated using Kaplan–Meier and log-rank tests between groups. Results: The follow-up was 100% complete with a mean time of 5.3 ± 3.3 years. The 30-day in-hospital mortality was 3.1% in tricuspid aortic valve group and 3.4% in bicuspid aortic valve group patients. The overall survival rates at 10 years did not differ between bicuspid aortic valve and tricuspid aortic valve patient groups (96.6 ± 3.3% vs. 90.3 ± 4.2%, p = 0.3). Freedom from recurrent aortic valve regurgitation (>2+) at 10 years was 90.5 ± 4.1% in tricuspid aortic valve group and 75.7 ± 8.7% in bicuspid aortic valve group (p = 0.06). Freedom from aortic valve reoperation at 10 years was 100% in tricuspid aortic valve group and 83.9 ± 7.4% in bicuspid aortic valve group (p = 0.002). Conclusion: Aortic valve sparing aortic root reimplantation surgery is a safe and efficient technique, providing acceptable long-term survival with low rates of valve-related complications in both tricuspid aortic valve and bicuspid aortic valve patient groups. However, aortic valve reoperation rates at 10 years follow-up were higher in bicuspid aortic valve group patients compared to tricuspid aortic valve group patients.

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Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa083 ◽

2020 ◽

Vol 58 (1) ◽

pp. 86-93 ◽

Cited By ~ 3

Author(s):

Erik Beckmann ◽

Andreas Martens ◽

Heike Krüger ◽

Wilhelm Korte ◽

Tim Kaufeld ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valves ◽

Term Outcome ◽

Long Term Outcome ◽

Initial Surgery ◽

Bicuspid Aortic Valves ◽

Valve Sparing

Abstract OBJECTIVES Aortic valve-sparing root replacement is an excellent treatment option for patients with intact tricuspid aortic valves. However, the durability in patients with bicuspid aortic valves is still a matter of debate. The aim of this study was to analyse the short- and long-term outcomes in patients with bicuspid aortic valves. METHODS Between July 1993 and October 2015, a total of 582 patients underwent the David I procedure, 50 of whom had a bicuspid aortic valve. In these patients, the mean age was 46 ± 13 years, and 80% (n = 40) were men. Follow-up was complete for 100% of patients and comprised a total of 552 patient-years with a mean follow-up time of 11 ± 5.2 years. RESULTS In addition to the David procedure, cusp plication was performed in 34% (n = 17) of patients and commissure repair in 8% (n = 4) of patients. There were no in-hospital deaths, and 1 patient (2%) had a perioperative stroke. The 1-, 5-, 10- and 20-year survival rates of patients after discharge were 98%, 94%, 88% and 84%, respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 20 years after initial surgery were 98%, 88%, 79% and 74%, respectively. Long-term freedom from reoperation was comparable to that of patients with tricuspid aortic valves (P = 0.2). CONCLUSIONS The David procedure has excellent short-term results in patients with a bicuspid aortic valve. In this study, the long-term durability of reimplanted bicuspid aortic valves was comparable to that of tricuspid valves. However, careful patient selection might have contributed to this, and further studies might be needed to definitely clarify this issue.

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Mid and Long-term Valve Stability Following Valve Sparing Aortic Root Replacement: Outcomes in Bicuspid Aortic Valve Compared with Tricuspid Aortic Valve

Structural Heart ◽

10.1080/24748706.2019.1589256 ◽

2019 ◽

Vol 3 (sup1) ◽

pp. 133-133

Author(s):

Lionel Camilleri ◽

Nicolas d’Ostrevy ◽

Adama Sawadogo ◽

Céline Lambert ◽

Etienne Geoffroy ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Aortic Root Replacement ◽

Tricuspid Aortic Valve ◽

Valve Sparing

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Long-term follow-up of supra-annular pulmonary autograft aortic root replacement in patients with bicuspid aortic valve☆

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.05.056 ◽

2008 ◽

Vol 34 (3) ◽

pp. 583-588 ◽

Cited By ~ 5

Author(s):

Feyzan Özaslan ◽

Thomas Wittlinger ◽

Nadejna Monsefi ◽

Tamimount Bouhmidi ◽

Sinthu Theres ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Aortic Root Replacement ◽

Pulmonary Autograft ◽

Long Term Follow Up

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Aortic Valve Intervention During Aortic Root Surgery in Children: A Systematic Review

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120926979 ◽

2020 ◽

Vol 11 (5) ◽

pp. 611-618

Author(s):

Maria Rodriguez ◽

Anahita Malvea ◽

Dayre McNally ◽

Vid Bijelic ◽

Ming Guo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Small Sample Size ◽

Case Series ◽

Small Sample ◽

Aortic Root Surgery ◽

Valve Sparing ◽

One Year

Background: Pediatric aortic root dilatation is a life-threatening condition that lacks guidelines for surgical management. We aimed to analyze the data on aortic valve interventions during root surgery to guide decision-making. Methods: A search was performed of MEDLINE, Embase, CENTRAL, ClinicalTrials.gov , and WHO ICTRP. Citations were screened in duplicate and independently to identify randomized controlled trials, cohorts, and case series involving populations aged 0 to 18 years, who received valve-sparing and valve-replacing aortic root surgeries between 1999 and 2019. Outcomes considered included mortality (perioperative, one year, five year), reintervention rates. Results: After duplicate removal, 689 citations were screened through abstract and full text review, identifying five eligible studies. All five were observational studies evaluating valve-sparing procedures. There were 81 patients with a mean study age range of 9.9 to 13.9 years. Both reimplantation (74%) and remodeling (26%) subtypes were done. Range of mean duration of follow-up was 1.2 to 4.4 years. There was no mortality reported until the one-year follow-up period. The long-term mortality rate was calculated as 0.02 per patient-year (95% CI: 0.01-0.05). The long-term reintervention rate was 0.08 per patient-year (95% CI: 0.05-0.13). Conclusions: There is limited experience on aortic valve intervention during aortic root surgery in children. Single-arm studies on valve-sparing surgeries show excellent survival up to one year. Mortality and reintervention rates increase in the longer term. The small sample size and lack of controlled studies do not allow for direct comparisons between procedure types.

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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.

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Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

10.22541/au.163256960.06606439/v1 ◽

2021 ◽

Author(s):

Mahmoud Alhussaini ◽

Eric Jeng ◽

Tomas Martin ◽

Amber Filion ◽

Thomas Beaver ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection ◽

Valve Sparing

Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

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