scholarly journals Pirmosios aortos vožtuvą išsaugančios operacijos šalinant kylančios aortos aneurizmas Vilniaus universiteto Širdies chirurgijos centre

2007 ◽  
Vol 5 (4) ◽  
pp. 0-0
Author(s):  
Vytautas Sirvydis ◽  
Saulius Raugelė ◽  
Arimantas Grebelis ◽  
Gintaras Turkevičius ◽  
Rimantas Karalius ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Marfan Syndrome ◽  
Heart Surgery ◽  
Anticoagulation Therapy ◽  
Ascending Aorta ◽  
University Hospital ◽  
Aorta Aneurysm ◽  
Valve Sparing ◽  
Vilnius University ◽  
Surgery Center

Vytautas Sirvydis1,  Saulius Raugelė1, Arimantas Grebelis1,  Gintaras Turkevičius2, Rimantas Karalius1, Rasa Čypienė1, Palmyra Semėnienė11 Vilniaus universiteto Širdies chirurgijos centras2 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Šiuolaikinė kardiochirurgija leidžia radikaliai chirurgiškai gydyti Marfano sindromu sergančius ligonius, kuriems diagnozuojama kylančios aortos aneurizma. Vienas iš pirmųjų metodų buvo sukurtas ir aprašytas Benthallio ir DeBono 1968 m., o 1992 m. Davidas aprašė operaciją, kurios metu išsaugomas natūralus aortos vožtuvas. Vėliau ši technika tobulinta, sukurta dar keletas panašių būdų. Nors ši metodika, atrodytų, leidžia išspręsti keletą problemų, tokių kaip antikoaguliantų vartojimas, tačiau diskusijų tebekelia jos naudojimas esant Marfano sindromui, kai aneurizma yra didesnė nei 50–55 mm. Supažindiname su pirmosiomis sėkmingomis aortos vožtuvą išsaugančiomis operacijomis šalinant kylančios aortos aneurizmas. Ligoniai ir metodai 2003–2006 m. Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centre atliktos keturios izoliuotos Davido I tipo operacijos Marfano sindromu sergantiems ligoniams, turintiems kylančios aortos lėtinę aneurizmą. Operuota dvi moterys ir du vyrai, amžiaus vidurkis 32,5 ± 5,7 m., visi buvo NYHA II funkcinės klasės. Retrospektyviai surinkti širdies echoskopijos duomenys iki ir po operacijos. Rezultatai Ritmo sutrikimų ar kitų grėsmingesnių komplikacijų, mirčių nebuvo. Aortos matmenys tiek ties sinotubuline jungtimi, tiek kylančios dalies skyrėsi statistiškai reikšmingai ir smarkiai, aortos vožtuvo nesandarumo nebuvo arba buvo menkas. Išvados Marfano sindromu sergantiems ligoniams, turintiems lėtinę kylančios aortos aneurizmą, aortos vožtuvą išsaugančios operacijos yra užtektinai saugus gydymo metodas. Literatūros ir mūsų duomenimis, šio tipo operacijos gali būti atliktos, kol aneurizmos dydis yra 50–55 mm ir nėra reikšmingo aortos vožtuvo nesandarumo. Pagrindiniai žodžiai: Marfano sindromas, aortos aneurizma, Davido operacija First experience of aortic valve sparing procedures in patients with aneurysm of ascending aorta at Vilnius University Hospital Santariškių Klinikos Heart Surgery Center Vytautas Sirvydis1,  Saulius Raugelė1, Arimantas Grebelis1,  Gintaras Turkevičius2, Rimantas Karalius1, Rasa Čypienė1, Palmyra Semėnienė11 Heart Surgery Center of Vilnius University2 Vilnius University Hospital Santariškių Klinikos Heart Surgery Center,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objectives The methods of modern cardiac surgery allow to perform a thoroughgoing treatment of ascending aorta aneurysm. Benthall and DeBono in 1968 were the first to describe the basic surgical technique; in 1992 David reported a novel surgical procedure aimed to spare the native aortic valve. The latter technique is superior because of permanent anticoagulation therapy exclusion, but also it is controversial in cases when ascending aorta aneurysm exceeds 55 mm, especially in patients with Marfan syndrome. We would like to introduce our first experience in treating ascending aorta aneurysm and sparing the aortic valve in patients with Marfan syndrome. Patients and methods There were 4 successful cases of David I procedure during 1996–2006 at Vilnius University Hospital Santariškių Klinikos Heart Surgery Center. The patients were 2 male and 2 female, mean age 32.5 ± 5.7 years; all were of NYHA II functional class. Data were collected retrospectively from case histories. Results There were no deaths of any rhythm disturbances after surgery. The parameters of the ascending aorta and aortic root were significantly different as compared with preoperative data. Also, after surgery there were no aortic insufficiency or it was trivial. Conclusions The aortic valve sparing procedure in patients with Marfan syndrome and ascending aorta aneurysm appears to be a safe method of treatment. According to the literature and our data, these operations are safe and effective when the aneurysm does exceed 55 mm and there is no aortic valve insufficiency. Key words: aortic aneurysm, Marfan syndrome, David procedure

scholarly journals Rizikos veiksnių įtaka ligonių išgyvenimui po kylančiosios aortos aneurizmos korekcijos konduitu

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Rasa Joana Čypienė ◽  
Palmyra Semėnienė ◽  
Arimantas Grebelis ◽  
Gintaras Turkevičius
Keyword(s):  
Risk Factors ◽  
Heart Surgery ◽  
Ascending Aorta ◽  
Functional Class ◽  
Aorta Aneurysm ◽  
Valve Insufficiency ◽  
Group 3 ◽  
Vilnius University ◽  
Group 2 ◽  
Surgery Center

Rasa Joana Čypienė1, Palmyra Semėnienė1, Arimantas Grebelis1, Gintaras Turkevičius21 Vilniaus universiteto Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Tikslas Analizuoti rizikos veiksniai 221 ligonio, kuriam atlikta kylančiosios aortos aneurizmos esant aortos vožtuvų nesandarumui, korekcija konduitu. Ligoniai ir metodai Darbas atliktas Vilniaus universiteto Širdies chirurgijos centre. Ligoniai stebėti nuo vieno mėn. iki 20 metų po operacijos. Pacientai tirti suskirstyti į šias tris grupes pagal klinikinę eigą:• 1 grupė – ūminė sluoksniuojančioji kylančiosios aortos aneurizma (ŪSA) – 48 (21,7%) ligoniai, vidutinė simptomų atsiradimo trukmė – 0,25 ± 0,11 mėn.• 2 grupė – lėtinė sluoksniuojančioji kylančiosios aortos aneurizma (LSA) – 44 (19,9%) ligoniai, vidutinė simptomų atsiradimo trukmė – 24,4 ± 5,26 mėn.• 3 grupė – lėtinė nesisluoksniuojančioji kylančiosios aortos aneurizma (LNA) – 129 (58,4%) ligoniai, vidutinė simptomų atsiradimo trukmė – 44,6 ± 5,06 mėn. Priešoperacinė vidutinė funkcinė klasė (f. kl.) (NYHA) klinikinėse grupėse atitinkamai buvo: 4,5 ± 0,08; 4,0 ± 0,12 ir 3,5 ± 0,05. Rezultatai Išskirta 14 (p < 0,01) reikšmingų rizikos veiksnių, turėjusių įtakos ligonių išgyvenimui – amžius, ligos trukmė, priešoperacinė funkcinė klasė, skausmas už krūtinkaulio, šokas, priešoperacinis miokardo infarktas Q+, KSdd, KSH, sistolinis arterinis kraujospūdis, DKA trukmė, galvos smegenų kraujotakos nepakankamumas, kairiojo skilvelio išmetimo frakcija, kylančiosios aortos skersmuo. Koreliacinė analizė parodė, kad yra glaudus tiesinis priešoperacinės f. kl. ir DKA trukmės – r = 0,374 (p = 0,01) ryšys. Išvados Analizė parodė, kad ligonių išgyvenimui tiek hospitaliniu, tiek atokiu periodais turėjo įtakos nustatyti reikšmingi rizikos veiksniai pagal klinikinę eigą. Pagrindiniai žodžiai: kylančiosios aortos aneurizma Effects of risk factors on patients’ survival after replacement of ascending aorta aneurysm with aortic valve insufficiency using conduit Rasa Joana Čypienė1, Palmyra Semėnienė1, Arimantas Grebelis1, Gintaras Turkevičius21 Vilnius University, Heart Surgery Center, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Heart Surgery Center,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Objective Risk factors were analyzed for 221 patients after replacement of ascending aorta aneurysm with aortic valve insufficiency using a conduit. Patients and methods Work was accomplished at Vilnius University Heart Surgery Center. Patients were followed up from 1 month to 20 years after operation. By the clinical course they were divided into three groups:group 1 – acute dissecting aortic aneurysm (ADA) – 48 (21.7%);group 2 – chronic dissecting aortic aneurysm (CHDA) – 44 (19.9%);group 3 – chronic aneurysm without dissection (CHAWD) – 129 (58.4%) patients. The mean period of anamnesis was in group 1 – 0.25 ± 0.11 months; group 2 – 24.4 ± 5.26 months; group 3 – 44.6 ± 5.06 months. The preoperational mean functional class in the groups was 4.5 ± 0.08; 4.0 ± 0.12 and 3.5 ± 0.05 respectively. Results There were 14 significant risks factors which have an impact on the survival of patients: age, period of anamnesis, preoperational functional classes, pain over the breastbone, preoperational myocardial infarction Q+, LVDD, LVH, systolic arterial hypertension, cardiopulmonary bypass (CPB) term, head cerebra failure, ejection fraction, ascending aorta diameters. Correlation analysis showed a close relation between preoperation functional class and CPB term r = 0.374 (p = 0.01). Conclusions Significant risk factors in different group of patients influenced their both in-hospital and follow-up survival. Key words: ascending aorta aneurysm

scholarly journals Ūminės kylančiosios aortos disekacijos chirurginio gydymo rezultatai

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Gintaras Turkevičius ◽  
Vytautas Sirvydis ◽  
Arimantas Grebelis ◽  
Rasa Čypienė ◽  
Palmyra Semėnienė ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Heart Surgery ◽  
Postoperative Bleeding ◽  
Multiple Organ ◽  
Ascending Aorta ◽  
University Hospital ◽  
Long Term Results ◽  
Vilnius University

Gintaras Turkevičius1, Vytautas Sirvydis1, Arimantas Grebelis1, Rasa Čypienė1, Palmyra Semėnienė1, Vilija Jakumaitė2, Gediminas Kitra2, Gediminas Kundrotas2, Pranas Šerpytis3 1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinikos Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius El. paštas: [email protected] Klaipėdos jūrininkų ligoninė3 Vilniaus universiteto Kardiologijos ir angiologijos centras Darbo tikslas: Išanalizuoti ligonių, sergančių ūmine kylančiosios aortos disekacija, chirurginio gydymo rezultatus. Ligoniai ir metodai: 1997–2007 metais operuoti 89 ligoniai, sergantys ūmine aortos disekacija. Išanalizuota ligonių priešoperacinė būklė, pasirinktas širdies operacijos metodas, ankstyvieji ir vėlyvieji gydymo rezultatai. Rezultatai: Pooperaciniu laikotarpiu mirė 26 ligoniai (29,2 %). Mirties priežastys: nesustabdomas pooperacinis kraujavimas – 11, širdies nepakankamumas – 5, galvos smegenų pažeidimas – 8 ir dauginis organų nepakankamumas – 2 ligoniams. Labiausiai kraujavo operuojant Bental de Bono metodika. Priešoperaciniu laikotarpiu 23 ligoniams (25,8 %) diagnozuota širdies tamponada ir akivaizdus širdies nepakankamumas. Iš šių ligonių 19 (82,6 %) teko atlikti retorakotomiją dėl kraujavimo ir 6 (26,0 %) gydyti sunkų inkstų funkcijos nepakankamumą. Vėlyvuoju laikotarpiu iš išgyvenusių 63 ligonių du mirė nepraėjus 12 mėnesių, 5 – praėjus 1–6 metams po operacijos. Išvados: Kylančiosios aortos disekacijos operacinio gydymo rezultatai priklauso nuo ligonių būklės prieš operaciją ir operacijos pobūdžio. Širdies tamponada prieš operaciją ir didelio laipsnio širdies nepakankamumas labai didina operacijos riziką. Vėlyvieji chirurginio gydymo rezultatai yra geri. Reikšminiai žodžiai: kylančioji aorta, disekacija, chirurgija Acute dissection of ascending aorta: data of surgical treatment Gintaras Turkevičius1, Vytautas Sirvydis1, Arimantas Grebelis1, Rasa Čypienė1, Palmyra Semėnienė1, Vilija Jakumaitė2, Gediminas Kitra2, Gediminas Kundrotas2, Pranas Šerpytis3 1 Vilnius University, Clinic of Cardiovascular Diseases, Heart Surgery Centre, Vilnius University Hospital Santariškių Clinics, Santariškių str. 2, LT-08661 Vilnius, Lithuania E-mail: [email protected] Klaipėda Seamen’s Hospital3 Vilnius University, Cardiology and Angiology Centre Objective: The aim of present study was to analyze the results of surgical treatment of patients suffering from dissecation of the ascending aorta. Patients and methods: During the period 1997–2007, 89 patients underwent operations because of acute dissecation of aorta. The preoperative data, methods of surgery and short-term as well as long-term results of treatment were analyzed. Results:There were 26 postoperative deaths (29.2  %). The causes of death included fatal postoperative bleeding (11), heart failure (5), brain impairment (8), multiple organ insufficiency (2). Bleeding was mostly characteristic of Bental-De Bono operations. In 23 patients (25.8  %), heart tamponade and marked heart failure were diagnosed preoperatively. In 19 of these patients (86.2  %), a rethoracotomy was required because of bleeding, and 6 (26.2  %), suffered from marked renal insufficiency. Seven of 63 survivors died during the long-term observation period (the survival time in two patients was up to 1 year, and 5 patients survived 1–6 years after the operation). Conclusion: The results of surgery for ascending aorta dissection depend on the preoperative condition of the patients and the mode of operation. The preoperative cardiac tamponade with a marked heart failure increases the risk of operation. The long-term results of the treatment are excellent. Key words: ascending aorta, dissection, surgery.

Ascending aorta and aortic root replacement (with or without valve sparing) in early childhood: surgical strategies and long-term outcomes

2019 ◽  
Author(s):  
Anne Moreau de Bellaing ◽  
Margaux Pontailler ◽  
Fanny Bajolle ◽  
Régis Gaudin ◽  
Bari Murtuza ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Young Children ◽  
Marfan Syndrome ◽  
Aortic Root ◽  
Surgical Techniques ◽  
Ascending Aorta ◽  
Long Term Results ◽  
Short Period ◽  
Valve Sparing

AbstractOBJECTIVESAortic root and ascending aorta replacements (AARs) are rarely required in the paediatric population. We report here a series of AAR performed in young children using different surgical techniques.METHODSBetween 1995 and 2017, 32 children under the age of 10 years (median age 5.4 years) underwent AAR procedures at our institution. Twenty-two (69%) had a connective tissue disease (infantile Marfan syndrome or Loeys–Dietz syndrome). We performed 11 AAR using a composite graft with a mechanical prosthesis and 21 valve-sparing procedures (10 Yacoub operations and 11 David operations). Median follow-up for operative survivors was 7.7 years (interquartile range 4.2–12.8 years).RESULTSThe cardiac-related early mortality rate was 6%. Patient survival was 91% at both 1 and 10 years. Eleven survivors (38%), all with a status of post-valve-sparing procedure, required an aortic root reintervention with an aortic valve replacement after a median interval of 4.2 years. Interestingly, only patients with infantile Marfan syndrome tended to be associated with risk of reoperation.CONCLUSIONSAortic root and AARs are safe in young children whatever the surgical procedure. Aortic valve-sparing procedures show good long-term results except in children with infantile Marfan syndrome whose ineluctable aortic annulus dilatation or aortic valve regurgitation requires reintervention after a short period.

scholarly journals AVIATOR: An open international registry to evaluate medical and surgical outcomes of aortic valve insufficiency and ascending aorta aneurysm

2019 ◽  
Vol 157 (6) ◽  
pp. 2202-2211.e7 ◽  
Author(s):  
Frederiek de Heer ◽  
Jolanda Kluin ◽  
Gebrine Elkhoury ◽  
Guillaume Jondeau ◽  
Maurice Enriquez-Sarano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Surgical Outcomes ◽  
Ascending Aorta ◽  
Aortic Valve Insufficiency ◽  
Aorta Aneurysm ◽  
International Registry ◽  
Valve Insufficiency

scholarly journals Modified conduit preparation creates a pseudosinus in an aortic valve–sparing procedure for aneurysm of the ascending aorta

1995 ◽  
Vol 109 (6) ◽  
pp. 1049-1058 ◽  
Author(s):  
Richard P. Cochran ◽  
Karyn S. Kunzelman ◽  
A.Craig Eddy ◽  
Bradley O. Hofer ◽  
Edward D. Verrier
Keyword(s):  
Aortic Valve ◽  
Ascending Aorta ◽  
Valve Sparing

Early and Long-Term Results of a Valve-Sparing Operation for Marfan Syndrome

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Emma J. Birks ◽  
Carole Webb ◽  
Anne Child ◽  
Rosemary Radley-Smith ◽  
Magdi H. Yacoub
Keyword(s):  
Infective Endocarditis ◽  
Marfan Syndrome ◽  
Ascending Aorta ◽  
Long Term Results ◽  
Thromboembolic Complications ◽  
Actuarial Survival ◽  
Acute Dissection ◽  
Valve Sparing

Background —We have previously described the experience, rationale, and development of a valve preserving technique, but its role in patients with Marfan syndrome has not previously been defined. Here, we attempt to determine the early and long-term results, timing, and determinants of outcome of this operation in patients with Marfan syndrome. Methods and Results —Since 1979, 82 patients (73.2% of all patients with Marfan syndrome undergoing resection of aneurysm of the ascending aorta) were operated on using this technique. Ages ranged from 2 to 69 years (mean, 33.9 years). In all, there were 4 early deaths (4.9%), 2 with acute dissection and 2 with chronic aneurysm operated on as emergencies. There were no early deaths in 67 patients operated on electively. Actuarial survival for patients operated for chronic aneurysm was 94.2%, 94.2%, and 94.2% at 1, 5, and 10 years, respectively; that for acute dissection was 72.7%, 63.6%, and 63.6%; and that for chronic dissection was 100%, 85.7%, and 75.0%. The probability of needing reoperation was 5.7%, 17.3%, and 17.3% at 1, 5, and 10 years. There were no instances of infective endocarditis or thromboembolic complications except in 2 patients operated on early in the series who had cusp extension. At the end of the follow-up, trivial or no aortic regurgitation was demonstrated in 33.3%, mild in 45.6%, moderate in 21.1%, and severe in 0. Conclusions —Valve-sparing operations are feasible in most patients with Marfan syndrome; they are applicable to patients with both dissection and chronic aneurysm. The early and long-term results are encouraging. Results are better in the absence of dissection, and prophylactic operation is warranted in some cases.

PW080 Ascending aorta aneurysm complicating bicuspid aortic valve stenosis

Global Heart ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e276-e277
Author(s):  
Majdi Gueldich ◽  
Ellouze Tarak ◽  
ahmed tounsi ◽  
abid dorra ◽  
faten triki ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Ascending Aorta ◽  
Aorta Aneurysm

scholarly journals Our management in vascular Behçet patients with ascending aorta aneurysm: 6 years’ experience

2020 ◽  
Vol 7 (4) ◽  
pp. 950
Author(s):  
Emin C. Ata ◽  
Metin O. Beyaz
Keyword(s):  
Aortic Valve ◽  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Survival Rates ◽  
Behcet's Disease ◽  
Aorta Aneurysm ◽  
Bentall Procedure ◽  
Valve Structure ◽  
Valve Sparing

Background: Ascending aortic involvement in Behçet’s disease is very rare, and often accompanied by aortic root dilatation. In cases with aortic valve insufficiency without valve structure impairment, valve-sparing surgery can be performed. This study aimed to investigate the mid-term results of patients with ascending aortic involvement and selected surgical procedures according to the valve structure among those vascular Behçets disease.Methods: A total of 13 Behçet’s disease with aortic involvement operated at our center from January 2012 to 2018 was retrospectively investigated. Bentall or david valve-sparing operations were preferred according to the aortic valve status. Postoperative echocardiography and computed tomography imaging was performed periodically for aortic valve competence and pseudoaneurysm formation.Results: Bentall procedure was performed in 7 (54%) patients, and 6 (46%) patients were undergone valve-sparing David procedure. Operative mortality was 7.7%, one patient died of major gastrointestinal bleeding 3 months after the operation. After 51±23 (ranged 23 to 94) months of follow-up, no other mortality occurred, overall survival rates were 84.6%, two patients had minimally aortic regurgitation and one patient had mild regurgitation in David procedure. In Bentall procedure, no paravalvular leakage was found during follow-up.Conclusions: The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.

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