Successful case of Benthal de Bono surgery in Cabrol modification with one-step aortic arch prosthesis and repeat coronary artery bypass surgery in a patient with de Bakey type 1 acute aortic dissection

The ascending aortic aneurysm occurs in 45 % of cases from the total number of aortic aneurysms of various localization. The incidence rate of combination of the aortic disease with aneurysm per 100 000 of the population is 5.9. The problem of prosthetics of the aortic root and aortic valve due to aneurysm and the changed AV is rather actual. The main principle of aneurysm surgery is the prevention of the risk of dissection and rupture with reconstruction of normal dimensions of the ascending aorta. Currently, there are different techniques for the treatment of root aneurysms and ascending aorta. The standard techniques are aortic root replacement, aortic valve reconstruction with replacement of aortic root or ascending aorta and partial or full replacement of aortic arch depending on the situation. The Bentall De Bono operation at present remains a golden standard of surgical treatment of the aneurysms of the root and ascending aorta with changed aortic valve. This surgery can have the following complications: thrombotic, thromboembolic followed by conduit dysfunction, formation of false anastomosis aneurysms, hemorrhage, compression of coronary artery orifices due to tension in the zone of coronary anastomoses.

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Endovascular Reconstruction from Aortic Valve to Aortic Arch Using One-Piece Valved-Fenestrated Stent Graft with a Branch: A Proof-of-Concept Study

The Heart Surgery Forum ◽

10.1532/hsf.2585 ◽

2019 ◽

Vol 22 (5) ◽

pp. E380-E384 ◽

Cited By ~ 2

Author(s):

Tao Li ◽

Xianhao Bao ◽

Jiaxuan Feng ◽

Zhenjiang Li ◽

Junjun Liu ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Arch ◽

Stent Graft ◽

Coronary Arteries ◽

Aortic Root ◽

Ascending Aorta ◽

Sinus Of Valsalva ◽

Fenestrated Stent Graft ◽

Transapical Access

Objective: To explore the feasibility of endovascular reconstruction of aortic root including aortic valve, sinus of valsalva and ascending aorta by a single stent-graft, a novel valved stent-graft with two fenestrae for preserving the coronary arteries was designed and performed in-vitro on a pig heart based circulation simulating system. Methods: Pig hearts were harvested from 30 healthy adult female pigs weighing between 60-65 kilograms. Before sacrifice, all the pigs received aortic computed tomography angiography (CTA) examinations and morphologic parameters of aortic root were measured. Then we customized the valved stent-grafts according to the CTA measurements. After the pig heart was fixed on the special platform according to the original orientation and connected to the circulation system, the stent graft was delivered through transapical access and covered the segment from aortic annulus to proximal part of aortic arch under DSA (digital subtraction angiography) guidance. Then changes of coronary flow before and after the procedure and fenestration alignment with coronary ostia were analyzed. Results: The overall technical success rate was 100%. The valve functions tested by ultrasound were in good condition under 120 mmHg circulation pressure. The flow of left coronary artery (LCA) did not decrease, but increased after the stent-graft implantation (340 ± 2.06 mL/min versus 288 ± 5.29 mL/min, P < .05). Similarly, the flow of right coronary artery (RCA) also increased (392 ± 9.17 mL/min versus 348 ± 8.01 mL/min; P < .05). The final angiography confirmed that both coronary arteries were patent. When generally observed from outer wall of valsalva sinus, both RCA and LCA orifices were aligned with the fenestrae. In 4 cases, the autologous valve leaflets blocked nearly 20% of the LCA fenestra’s area, but the flow did not significantly decrease in these cases. Conclusion: Stimulated on a pig heart-based circulation simulation system, the one-piece valved-fenestrated stent graft with a branch could be delivered via the transapical access and deployed accurately, which achieved endovascular reconstruction of aortic valve, sinus of valsalva and ascending aorta while preserving the coronary artery perfusion by fenestrations. More in-vivo experiments on animal models are mandatory to further verify its efficacy and safety.

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Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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Clinical case: aortic valve replacement with aortic root reconstruction and coronary artery bypass grafting in 73-yo obese female patient

Clinical Practice ◽

10.17816/clinpract09171-75 ◽

2018 ◽

Vol 9 (1) ◽

pp. 71-75

Author(s):

D. V. Borisov ◽

A. S. Zotov ◽

S. A. Vachev ◽

A. V. Troitskiy ◽

R. I. Khabazov

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Female Patient ◽

Valve Replacement ◽

Aortic Root ◽

Artery Bypass ◽

Bypass Grafting ◽

Obese Female

Aortic valve replacement is the second most common cardiac surgery procedure. Prosthesis-patient size mismatch can increase the incidence of adverse events postoperatively, it also leads to increased left ventricular load. Some studies describe the higher mortality in this group of patients. It is also proved that patients with severe aortic stenosis usually have impaired platelet aggregation and low von Willebrand factor causing bleeding disorders. We report a case of successful aortic valve replacement and aortic root enlargement (Nicks technique) combined with coronary artery bypass grafting (left internal mammary artery to the left anterior descending artery) and left atrial appendage resection in 73-y.o. obese female patient. Postoperative course was uneventful.

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Long Term Outcomes of Freestyle Stentless Aortic Bioprosthesis: A Single Center Experience

The Heart Surgery Forum ◽

10.1532/hsf.2661 ◽

2020 ◽

Vol 23 (1) ◽

pp. E034-E038

Author(s):

Mehmet Ezelsoy ◽

Kerem Oral ◽

Kemal Tolga Saracoglu ◽

Ayten Saracoglu ◽

Zehra Bayramoglu ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Artery Bypass ◽

Clinical Results ◽

Aortic Aneurysms ◽

Aortic Cross Clamp Time ◽

Replacement Procedure ◽

Structural Valve Deterioration

Background: The study is presenting our long-term clinical results after freestyle stentless aortic root bioprosthesis replacement in patients with severe aortic insufficiency with ascending aortic aneurysm. Methods: Seventy-seven patients with ascending aortic aneurysms and aortic valve insufficiency underwent a total root replacement procedure using a stentless “Freestyle” valve (Medtronic Inc., Minneapolis, Minnesota). There were 50 (64.9%) men and 27 (35.1%) women. Mean age was 68.7 ± 11.1 years. The surgical procedure used a complete root replacement. Concomitant procedures included coronary artery bypass grafting in 15 (19.5%) patients. Results: The mean cardiopulmonary bypass time was 130.3 ± 26.4 minutes and total aortic cross clamp time was 99.5 ± 23.6 minutes. Hospital mortality was 2.6%. The median follow-up time was 11.2 years. The 5- and 10-years freedom from aortic valve reoperation were 97.4 ± 1.2% and 93.4 ± 4.9%, respectively. During 10 years follow up, there were 14 late deaths; 4 deaths were cardiac, and 10 deaths were noncardiac. Valve-related deaths were attributable to thromboembolism in 1 patient, endocarditis in 2 patients, and congestive heart failure in 1 patient. Conclusion: The freestyle stentless aortic root bioprosthesis offered good clinical outcomes, in terms of survival and structural valve deterioration. The Freestyle valve is a viable option for use in patients undergoing bioprosthetic aortic valve replacement and expected desire for long-term durability.

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Clinical case of hybrid treatment for a saccular aneurysm of the aortic arch

The Siberian Journal of Clinical and Experimental Medicine ◽

10.29001/2073-8552-2021-36-3-161-165 ◽

2021 ◽

Vol 36 (3) ◽

pp. 161-165

Author(s):

G. G. Nasrashvili ◽

M. S. Kuznetsov ◽

D. S. Panfilov ◽

B. N. Kozlov

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Arch ◽

Clinical Case ◽

Artery Bypass ◽

Treatment Options ◽

Ascending Aorta ◽

Bypass Grafting ◽

Hybrid Treatment ◽

Arch Aneurysm

The article presents a clinical case of a staged hybrid treatment for an aortic arch aneurysm in patient who previously underwent coronary artery bypass grafting and exoplasty of the ascending aorta. Possible alternative treatment options for this pathology are reviewed, and the features of surgical and endovascular treatment are also described.

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Oblique aortic valve replacement and coronary artery bypass grafting for severely calcified narrow aortic root with unstable angina

The Japanese Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/bf02913141 ◽

2001 ◽

Vol 49 (5) ◽

pp. 320-323

Author(s):

Toru Ishida ◽

Kiyoharu Nakano ◽

Akihiko Gomi ◽

Hayao Nakatani ◽

Tokuya Sato ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Unstable Angina ◽

Coronary Artery Bypass ◽

Valve Replacement ◽

Aortic Root ◽

Artery Bypass ◽

Bypass Grafting

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Aortic Arch Replacement without Deep Hypothermic Circulatory Arrest

Case Reports in Surgery ◽

10.1155/2021/8821182 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Zviad Bakhutashvili ◽

Lia Janelidze ◽

Kakhaber Beria ◽

Simon Matikashvili ◽

Eduard Limonjiani

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Circulatory Arrest ◽

Artery Bypass ◽

Deep Hypothermic Circulatory Arrest ◽

Ascending Aorta ◽

Hypothermic Circulatory Arrest ◽

Moderate Hypothermia ◽

Aortic Arch Replacement ◽

Valve Insufficiency

A 60-year-old man presented with a thoracic aortic aneurysm without rupture accompanied by severe nonrheumatic aortic valve insufficiency and unstable angina. Surgery was performed and included several steps: (1) resection and reconstruction of ascending aorta and aortic arch using a tube graft, (2) replacement of aortic valve using a biological prosthesis, and (3) coronary artery bypass grafting was performed with two distal anastomoses. All of these procedures were performed with total cardiopulmonary bypass without deep hypothermic circulatory arrest under conditions of moderate hypothermia using dual concurrent cannulation of the subclavian and femoral arteries.

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