Geometric changes in aortic root replacement using Freestyle prosthesis

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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Comparison of the geometry of the left ventricle outflow tract, the aortic root and the ascending aorta in patients with severe tricuspid aortic stenosis versus healthy controls

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-019-01715-5 ◽

2019 ◽

Vol 36 (2) ◽

pp. 357-366

Author(s):

Małgorzata Nieznańska ◽

Karina Zatorska ◽

Patrycjusz Stokłosa ◽

Małgorzata Ryś ◽

Piotr Duchnowski ◽

...

Keyword(s):

Left Ventricle ◽

Aortic Stenosis ◽

Aortic Root ◽

Ascending Aorta ◽

Outflow Tract ◽

Aortic Annulus ◽

Healthy Controls ◽

Sinus Of Valsalva ◽

Root Volume ◽

Imaging Geometry

Abstract The purpose of this study was to assess by multislice computed tomography (MSCT) imaging geometry of the ascending aorta, the aortic root, the aortic annulus and the left ventricle outflow tract (LVOT) in aortic stenosis (AS) patients, to compare aortic root morphology in patients with AS with healthy controls and to evaluate sex differences. Fifty patients with severe AS and 50 age- and gender-matched controls who underwent MSCT were included in the study. The dimensions of the LVOT, the aortic annulus, the aortic root, the ascending aorta, and the volume of the aortic root were retrospectively assessed and a comparison was made between patients with severe tricuspid AS and controls. Patients with tricuspid AS in comparison with controls had smaller dimensions of the sinus of Valsalva resulting in reduction of the aortic root volume, whereas the dimensions of the other structures were comparable. MSCT revealed larger annular, LVOT and the sinus of Valsalva dimensions and the aortic root volume in men than women. Men with AS differed from healthy men only in regard to the dimensions of the sinus of Valsalva, while women showed significant differences also in the LVOT, and the aortic annulus. MSCT showed accurately aortic root remodeling in tricuspid AS patients and indentified sex-dependent differences. Women with tricuspid AS differ from healthy women more than men did. A high degree of the variability in the aortic root dimensions requires further careful research.

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Proof of Concept of an Endoscopic Sutureless Valve Sizer

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000313 ◽

2016 ◽

Vol 11 (5) ◽

pp. 337-341 ◽

Cited By ~ 1

Author(s):

Marco Vola ◽

Juan Pablo Maureira ◽

Vito Giovanni Ruggieri ◽

Jean-François Fuzellier ◽

Salvatore Campisi ◽

...

Keyword(s):

Aortic Valve ◽

Early Stage ◽

Ascending Aorta ◽

Aortic Annulus ◽

Laboratory Evaluation ◽

Proof Of Concept ◽

Valve Size ◽

Sutureless Valve ◽

Selection Of

Objective In this paper, we present an endoscopic expandable sizer conceived to allow thoracoscopic aortic valve replacement with a sutureless prosthesis using a dynamic sizing of the aortic annulus. Methods Ten aortic torsos were prepared using a five-trocar thoracoscopic setting. Once the aortotomy was performed and the aortic valve leaflets removed, the technical feasibility of the endoscopic sizing (introduction into the trocar, expansion into the aortic annulus, determination of the valve size, and retraction) with the device was assessed. In case of successful thoracoscopic sizing, endoscopic implantation of a sutureless valve (five LivaNova Perceval prosthesis and five Medtronic 3f Enable bioprosthesis) was performed. Before ascending aorta closure, we assessed the appropriate sealing of the bioprosthesis in the native annulus with camera visualization and a nerve hook inspection. Results All the 10 endoscopic sizings were technically feasible. The scheduled aortic sutureless valve implantations were successfully performed. In all cases, fitting and placement of the sutureless bio-prosthesis in the flaccid heart was satisfactory, with no paraprosthetic leakage detectable by the nerve hook. Conclusions The use of the endoscopic expandable sizer is technically possible. In this early-stage test in the flaccid heart, selection of the valve size was satisfactory during thoracoscopic sutureless aortic bioprosthesis implantation. Further laboratory evaluation with fluid dynamics (aortic root pressurization) will be performed before a clinical study is started.

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The use of innominate artery cannulation for antegrade cerebral perfusion in aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01249-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Eden C. Payabyab ◽

Jonathan M. Hemli ◽

Allan Mattia ◽

Alex Kremers ◽

Sohrab K. Vatsia ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Cerebral Perfusion ◽

Innominate Artery ◽

Type A ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Artery Cannulation ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

Abstract Background Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 min. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%). Conclusions This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases.

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Development of Multiple Aortic Mycotic Aneurysms After Cardiac Catheterization

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709617740907 ◽

2017 ◽

Vol 5 (4) ◽

pp. 232470961774090

Author(s):

Desiree A. Steimer ◽

John J. Squiers ◽

J. Michael DiMaio ◽

Katherine B. Harrington

Keyword(s):

Cardiac Catheterization ◽

Aortic Root ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Past Medical History ◽

History Of ◽

Mycotic Aneurysms

A 71-year-old male with a past medical history of coronary artery bypass surgery developed multiple, infected pseudoaneurysms of the ascending aorta and aortic root 1 year after cardiac catheterization. He underwent aortic root replacement with a 24-mm homograft. Tissue culture from operative specimens revealed invasive Aspergillus fumigatus infection. He was treated with voriconazole for 3 months. After 1 year, he had no recurrence of symptoms, pseudoaneurysm, or fungal infection.

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