scholarly journals Reinforced Aortic Root Reconstruction in Type A Aortic Dissection: A Prospective Study

2021 ◽  
Vol 24 (5) ◽  
pp. E828-E832
Author(s):  
Ahmed Elsharkawy ◽  
Ashraf El Midany ◽  
Ahmed Elwakeel ◽  
Eman Mahmoud ◽  
Ahmed Mohammed ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Prospective Study ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Early Results ◽  
The Mean ◽  
A Prospective Study

Background: Type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Many techniques have evolved to repair the dissected sinus segments and restore aortic valve dynamics. Herein, we evaluate the early outcome of a novel technique for reconstruction of dissected aortic root. Methods: A prospective study was conducted on 300 patients to evaluate the early results of repair of dissected root in type A aortic dissection. The mean age was 59.65±8.52 years, and 76% of patients were males. All patients had four standard steps for aortic reconstruction: 1) commissural resuspension; 2) right coronary sinus reinforcement with pericardial and Dacron bands; 3) non-coronary sinus reinforcement using external Dacron patch; 4) circumferential inversion of adventitial layer of the root. Patients were followed up clinically, echocardiographically, and by CT scan. Results: The in-hospital mortality was 8%. The mean cross-clamp time was 120±30 minutes, and circulatory arrest time was 25+10 minutes. Twenty-seven patients (9%) experienced postoperative complications, including bleeding and acute kidney injury. During a mean follow-up time of 48±12 months, there were no recurrent aortic dissection, aortic dilatation, pseudoaneurysm, or progression of aortic regurgitation during the entire study period. Conclusions: This reconstructive technique technically is undemanding, feasible, safe, and durable with good early results. A larger cohort of patients with longer period of follow up should generate a more powerful evaluation of this technique.

scholarly journals Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up

2013 ◽  
Vol 146 (6) ◽  
pp. 1456-1460 ◽  
Author(s):  
Angelo M. Dell'Aquila ◽  
Giovanni Concistrè ◽  
Alina Gallo ◽  
Stefano Pansini ◽  
Alessandro Piccardo ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection

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

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.

scholarly journals Outcomes of surgical treatment of Stanford type of aortic dissection at Hanoi Heart Hospital in the period 2015-2020

2022 ◽  
Vol 35 ◽  
pp. 138-149
Author(s):  
Nguyen Thai Minh ◽  
Le Quang Thien ◽  
Nguyen Sinh Hien ◽  
Nguyen Hoang Ha ◽  
Nguyen Dang Hung ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Survival Rate ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Early Mortality ◽  
Type A Aortic Dissection ◽  
The Mean ◽  
Heart Hospital

Background: Stanford type A aortic dissection is a complex disease and a serious surgical emergency. The diagnosis is determined based on diagnostic imagines. Surgery is the mainstay of treatment, with high mortality and morbidity. This study aimed to comment on clinical and paraclinical characteristics and evaluate the results of surgical treatment of type A aortic dissection at Hanoi Heart Hospital within 5 years from 2015 to 2020. Methods: Retrospective and descriptive study of patients diagnosed with type A aortic dissection who were surgically treated at Hanoi Heart Hospital from January 2015 to May 2020. Results: 109 cases were included in the study with the mean age of 56.0 ± 14.4; 50 - 60 age accounted for the highest percentage (30.3%); men accounted for 67.9%. Classic type A aortic dissection in 95 cases (87.2%). Chest pain was the main clinical symptom (91.7%); 4.6% came to the hospital in a state of cardiogenic shock and circulatory arrest. The rate of Marfan phenotype was 13.8%. The most common surgery is replacing the ascending aorta (45.9%); total replacement of the aortic arch accounted for 17.4%; Total root replacement and aortic arch accounted for 3.7%. The average aortic pairing time was 120.7 ± 41.0 minutes, the mean running time was 179.7 ± 57.0 minutes. Re-operative bleeding accounted for 6,4%; cerebrovascular accident accounted for 2,8%. The early mortality rate after surgery was 9.2%. The mean follow-up time was 24.93 ± 16.13 months, the mean survival time was 52.0 ± 1.9 months, the survival rate was 88.1% after 1 year and 85.3% after 5 years. Conclusion: Early mortality, postoperative complications and survival rate after follow-up were positive with surgical technique and conditions of anesthesia and resuscitation at Hanoi Heart Hospital.

Abstract 13583: Left Ventricular Remodeling After Type a Aortic Dissection Surgery: a Comparison Between Different Surgical Techniques

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Madelien V Regeer ◽  
Michel I Versteegh ◽  
Robert J Klautz ◽  
Martin J Schalij ◽  
Jeroen J Bax ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Ejection Fraction ◽  
Ventricular Remodeling ◽  
Surgical Techniques ◽  
Type A ◽  
Left Ventricular ◽  
Type A Aortic Dissection ◽  
The Mean ◽  
Lv Volumes

Introduction: Type A aortic dissection (AADA) requires emergency surgery with different options including valve-sparing aortic root replacement (VSRR), supracoronary ascending aorta replacement (SCR) and aortic valve and root replacement (AVRR). Recurrence of aortic regurgitation (AR) and extent of left ventricular (LV) remodeling in patients with AADA was compared between these surgical techniques. Methods: A total of 120 patients (59 ± 12 years, 63% male) with AADA who underwent VSRR (n=22), SCR (n=62) or AVRR (n=36) were included in the present retrospective evaluation. AR grade and LV volumes and ejection fraction were assessed postoperatively (before hospital discharge) and during follow-up. Estimated marginal means ± standard error of the mean were obtained using linear mixed models. Results: Patients who underwent VSRR were significantly younger (49 ± 6 years) and more often male (84%). There were more patients in SCR group with hypertension compared to VSRR and AVRR (67% vs. 27% and 47%; p=0.006). The EuroSCORE II was highest in patients who underwent AVRR. After a median follow up of 53 months, the mean AR grade was 1.2 ± 0.2 in VSRR vs. 1.8 ± 0.2 in SCR vs. 0.2 ± 0.1 in AVRR (p<0.001). LV end-diastolic and end-systolic volumes remained stable in VSRR, while a significant increase was observed in SCR (table). The ejection fraction remained stable in all groups, however, a trend towards improvement was observed in VSRR (p=0.055). Conclusions: Patients with AADA who underwent SCR experienced more AR compared to AVRR resulting in larger LV volumes during follow up. Despite higher AR grade during follow up in patients who underwent VSRR compared to AVRR; there was no deterioration in LV volumes and function after VSRR.

scholarly journals Preservation of the Aortic Root During Type A Aortic Dissection Surgery: An Effective Strategy?

Aorta ◽  
2021 ◽  
Author(s):  
Christophe Baufreton ◽  
Olivier Fouquet ◽  
Simon Dang Van ◽  
Jihed Laribi ◽  
Frédéric Pinaud ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Long Term Follow Up

Abstract Background Management of the aortic root during acute Type A aortic dissection (TAAD) repair remains controversial in term of long-term evolution and reoperation. The aim of this study was to assess the long-term outcomes of the aortic root after conservative management during primary surgery. Methods One hundred sixty-four consecutive patients were included in this monocentric retrospective study. The primary endpoint was reoperation on the aortic root during long-term follow-up. Forty-six patients had aortic root replacement (ARR) and 118 had supracoronary aortic replacement (SCR). The 10-year survival, occurrence of significant aortic regurgitation, and radiologic aortic root dilatation in each group were assessed during follow-up. Results Patients from ARR group were younger than those from SCR group (p < 0.0001). Median follow-ups of ARR group and SCR group are 4.4 (interquartile range [IR]: 2.6–8.3) and 6.15 (IR: 2.8–10.53) years, respectively. Reoperation of the aortic root during long-term follow-up was similar in both groups (ARR group: 5.1%, SCR group: 3.3%, p = 0.636). The 10-year survivals of ARR and SCR groups were 64.8 ± 12.3% and 46.3 ± 5.8% (p = 0.012), respectively. Long-term significant aortic regurgitation occurred in one patient (1.7%) and seven patients (7.6%) of the ARR and SCR groups (p = 0.176), respectively. Radiologic aortic root diameters in the SCR group were similar between postoperative period and follow-up studies (p = 0.58). Reoperation on the distal aorta (p = 0.012) and patent radiologic false lumen of the descending aorta (p = 0.043) were independent risk factors of late death. Conclusion SCR is an effective technique for primary TAAD surgery and does not increase the rate of late reoperation on the aortic root.

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