scholarly journals Clinical analysis of redo aortic root replacement after cardiac surgery: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jianying Deng ◽  
Qianjin Zhong
Keyword(s):  
Cardiac Surgery ◽  
Aortic Root ◽  
Prosthetic Valve Endocarditis ◽  
Clinical Analysis ◽  
Aortic Root Replacement ◽  
Aortic Sinus ◽  
Bentall Procedure ◽  
Replacement Procedure ◽  
Cardiac Procedure ◽  
Aortic Root Surgery

Abstract Objectives To explore the etiology, previous cardiac procedure methods and outcomes of redo aortic root replacement after cardiac surgery. Methods A retrospective analysis of 41 patients who underwent aortic root replacement surgery in our hospital from February 2010 to February 2020 who underwent at least one cardiac surgery in the past, including 27 males and 14 females, with an average age of 49.5 ± 10.2 years old. Indications for reoperation include: aortic sinus dilation and ascending aortic aneurysm in 20 cases (48.8%), recurrent aortic dissection in 7 cases (17.1%), pseudoaneurysm of aortic root in 4 cases (9.8%), prosthetic valve endocarditis in 5 cases (12.2%) and paravalvular leakage in 5 cases (12.2%). According to whether the previous procedure involved aortic root surgery, they were divided into 2 groups, namely aortic root surgery-involved (ARS) group and non-aortic root surgery-involved (NRS) group. After the patients were discharged from hospitals, follow-ups were carried out through outpatient clinic or telephone for 5 years. Kaplan-Meier was used for survival analysis. Results All patients underwent Bentall procedure with a median sternum incision. Six patients (14.6%) died during the postoperative hospitalization and 3 patients (8.6%) died during the follow-up. The 1-year, 3-year, and 5-year survival in ARS group were 92.6, 92.6, and 92.6%, respectively; the 1-year, 3-year, and 5-year survival in NRS group were 100, 85.7, and 85.7%, respectively. There was no statistical difference between the two groups in the cause of redo aortic root replacement, procedure time, postoperative complications, postoperative hospital stay, hospital mortality, and 5-year cumulative survival (p > 0.05). Conclusions Redo aortic root replacement is difficult and high risk. Bentall procedure is still a reliable surgical option for redo aortic root replacement, with good short- and mid-term results. The prognosis of redo aortic root replacement is not necessarily related to the etiology of patient’s surgery and the methods of previous cardiac procedure.

The Skirt and Collar of The Valsalva Graft: One Dress Fits All

2021 ◽  
Author(s):  
Raffaele Scaffa ◽  
Luca Weltert ◽  
Andrea Salica ◽  
Ruggero De Paulis
Keyword(s):  
Aortic Root ◽  
Complication Rates ◽  
Valve Prosthesis ◽  
Bentall Procedure ◽  
Aortic Root Surgery ◽  
Nominal Size ◽  
Mechanical Prostheses ◽  
Valved Conduit ◽  
Valve Sparing ◽  
Graft Diameter

In the original pre-formed Valsalva graft, the skirt is the defining feature. It is a self-expanding portion, obtained by 90° rotation of the Dacron fabric corrugation with respect to the rest of the graft. Due to this manufacturing feature, the skirt length is equal to the graft diameter and, once pressurized, it expands by 25-30% (up to 10 mm) from the nominal size. Proximal to this bulged portion, a small collar completes the prosthesis. By virtue of this anatomical design, the Valsalva graft is recommended for most aortic root surgeries including valve-sparing and Bentall procedures. The skirt, by recreating the pseudo-sinuses, represents the key feature of the graft when used for aortic valve-sparing procedures (remodeling and reimplantation). However, in the Bentall procedure, the graft collar is an important feature because it is useful to attach the Valsalva graft to the valve prosthesis sewing ring when making a valved conduit. Moreover, once the graft is pressurized, the whole volume of the skirt better accommodates the struts and the leaflets of biological and mechanical prostheses. Furthermore, the expanded skirt reduces the distance and the tension on the coronary button anastomosis, increasing safety and possibly reducing complication rates. This review demonstrates the versatility of the Valsalva graft in various scenarios of aortic root surgery, with special emphasis on different uses of the skirt and the collar.

Current Trends in Aortic Root Surgery

2018 ◽  
Vol 13 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Djamila Abjigitova ◽  
Georgia Panagopoulos ◽  
Oleg Orlov ◽  
Vishal Shah ◽  
Konstadinos A. Plestis
Keyword(s):  
Aortic Root ◽  
Circulatory Arrest ◽  
Ventilatory Support ◽  
Median Sternotomy ◽  
Aortic Root Replacement ◽  
Interquartile Range ◽  
Red Blood Cell Transfusion ◽  
Prolonged Length ◽  
Bentall Procedure ◽  
Significant Difference

Objective The mini-sternotomy approach is becoming a widespread technique for aortic valve surgery. However, its safety for aortic root replacement has yet to be established. The aim of the present study was to compare the operative outcomes of patients who underwent aortic root replacement via upper mini-sternotomy (mini-Bentall) to patients who underwent Bentall procedure via median sternotomy (full-sternotomy Bentall). Methods Between November 1998 and November 2016, 91 consecutive patients underwent full-sternotomy Bentall procedure and 26 patients underwent mini-Bentall procedure. The mini-Bentall procedure was performed via an upper hemisternotomy incision extending to the right fourth intercostal space. Patients with concomitant procedures and those who underwent deep hypothermic circulatory arrest were excluded from the analysis. Outcome variables were operative mortality and major surgical complications, including prolonged length of hospital stay, transfusion rates, reoperation for bleeding, and prolonged ventilatory support. Results No significant differences were observed on the preoperative, operative, and postoperative characteristics between the two treatment groups. The median cardiopulmonary bypass and aortic cross-clamp times were 169 minutes (interquartile range = 156.0–188.5) and 148 minutes (interquartile range = 131.3–160.3) in the mini-Bentall group, respectively. The median duration of hospitalization in the mini-Bentall group was 6.5 days (interquartile range = 5.0–11.0 days). In-hospital mortality and new renal insufficiency occurred at a frequency of 1.1% and reoperation for bleeding at 6.6% in the group of patients who underwent the conventional Bentall procedure compared with 0% for all these measures in the mini-Bentall group ( P > 0.33). There was no significant difference in intraoperative red blood cell transfusion and other major postoperative complications. No strokes were observed in either group, and there were no conversions to median sternotomy in the mini-Bentall group. Conclusions An upper hemisternotomy is a feasible technique in patients undergoing elective aortic root replacement surgery. However, future prospective studies are required before these procedures become the standard of care.

Aortic root replacement with cryopreserved allograft for prosthetic valve endocarditis

2002 ◽  
Vol 74 (3) ◽  
pp. 650-659 ◽  
Author(s):  
Joseph F. Sabik ◽  
Bruce W. Lytle ◽  
Eugene H. Blackstone ◽  
Antonino G.M. Marullo ◽  
Gosta B. Pettersson ◽  
...  
Keyword(s):  
Aortic Root ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Aortic Root Replacement

scholarly journals Is Additional Cardiac Procedure A Catastrophic Risk During Bentall Operation? Long Term Results in A Tertiary Center

2021 ◽  
Vol 16 (5) ◽  
Author(s):  
Mehmet Ali Yesiltas
Keyword(s):  
Cardiac Surgery ◽  
Long Term Results ◽  
Mortality And Morbidity ◽  
Single Center Experience ◽  
Bentall Procedure ◽  
Cardiac Procedure ◽  
Tertiary Center ◽  
Surgical Data ◽  
Group A ◽  
Group B

The aim of this study was to assess the influences of concomitant cardiac surgery on the risk for mortality and morbidity after Bentall procedure. This retrospective study was a review of patients who underwent Bentall procedure from a single center experience over a 7-year period. Demographic features, surgical data, postoperative period and outcomes were analyzed. Patients with isolated Bentall surgery (Group A) were compared and concomitant cardiac surgery with Bentall procedure were compared (Group B).

scholarly journals Fate of a coronary artery intramural haematoma complicating aortic root surgery: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
Giulio Folino ◽  
Raffaele Scaffa ◽  
Andrea Salica ◽  
Ruggero De Paulis
Keyword(s):  
Coronary Artery ◽  
Aortic Root ◽  
Artery Bypass ◽  
Healing Process ◽  
Bypass Graft ◽  
Intramural Haematoma ◽  
Coronary Syndrome ◽  
Bentall Procedure ◽  
Aortic Root Surgery ◽  
Life Threatening

Abstract Background Coronary intramural haematoma (CIH) is an uncommon but potentially life-threatening complication during aortic root surgery (such as Bentall procedure). Depending on its extension it can lead to cardiogenic shock. Documented reports of this complication are lacking in literature. Case summary In the report we present a case of CIH and its management and we show a stepwise imaging of the healing process that gives an insight of the fate of CIHs. Discussion This case raises awareness of CIH as differential diagnosis for myocardial ischaemia during aortic root surgery. It underlines the effectiveness of immediate surgical revascularization, highlights the potential temporary role of coronary artery bypass graft that can stabilize the acute coronary syndrome and may give time to the CIH to reabsorb and native coronary circulation to re-establish.

scholarly journals Biological versus mechanical Bentall procedure for aortic root replacement: a propensity score analysis of a consecutive series of 1112 patients†

2017 ◽  
Vol 52 (1) ◽  
pp. 143-149 ◽  
Author(s):  
Antonio Pantaleo ◽  
Giacomo Murana ◽  
Luca Di Marco ◽  
Giuliano Jafrancesco ◽  
Giuseppe Barberio ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aortic Root ◽  
Propensity Score Analysis ◽  
Aortic Root Replacement ◽  
Consecutive Series ◽  
Bentall Procedure ◽  
Score Analysis

scholarly journals Elective primary aortic root replacement with and without hemiarch repair in patients with no previous cardiac surgery

2017 ◽  
Vol 153 (6) ◽  
pp. 1402-1408 ◽  
Author(s):  
Ourania Preventza ◽  
Joseph S. Coselli ◽  
Matt D. Price ◽  
Katherine H. Simpson ◽  
Ouyang Yafei ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Root ◽  
Aortic Root Replacement
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