Short-term results of thoracic aorta aneurysm repair and aortic valve reimplantation

Aim: The study was designed to summarize short-term results of aortic valve reimplantation (David procedure) in patients suffering from thoracic aorta aneurysm and aortic valve insufficiency. Methods: 132 patients were operated for various types of aorta pathology and aortic valve insufficiency, including 56 patients with acute and subacute aortic dissection and 76 patients with chronic aortic aneurysm with or without dissection. Different types of surgical interventions were offered to patients: ascending aorta replacement with aortic valve reimplantation (88 cases), hemiarch replacement (11 cases), Borst procedure (17 cases), stent-graft implantation (16 cases) and other concomitant interventions including CABG, valve repair or replacement. The efficacy of aortic valve functioning was evaluated by using intraoperative transoesophageal ultrasound imaging in 129 cases and transthoracic ultrasound imaging in immediate postoperative period in 119 cases. Results: Satisfactory hemodynamic parameters of aortic valve functioning were recorded in the majority of patients: Grade 0 aortic insufficiency - 10 patients, Grade 1-1+ - 100 patients and Grade 2-2+ was registered in 10 patients. Despite the fact that functional parameters of the aortic valve following the David procedure were positive in most patients, overall hospital mortality ran to 12.1% (16 patients). Hospital mortality depended on the nature of intervention (emergency or elective surgery), as well as on the general complexity related with the extent of the intervention. In the group of patients who underwent emergency and elective interventions, hospital mortality accounted for 19.6% (11 patients) and 6.5% (5 patients) respectively. Conclusion: David procedure in patients suffering from ascending aorta aneurysm is an effective treatment option in terms of aortic valve functional recovery in cases of acute or chronic aortic valve insufficiency.

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

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.10.076 ◽

2019 ◽

Vol 157 (6) ◽

pp. 2202-2211.e7 ◽

Cited By ~ 6

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

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Approaches to aortic valve preservation in patients with aortic root an-eurysms and aortic insufﬁciency: the David procedure

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2009-15-2-142-145 ◽

2009 ◽

Vol 15 (2) ◽

pp. 142-145

Author(s):

V. Uspenskiy ◽

I. V. Sukhova ◽

M. L. Gordeev

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Aortic Insufficiency ◽

Aortic Valve Insufficiency ◽

Short Term ◽

Aortic Root Aneurysm ◽

Valve Insufficiency ◽

The Common ◽

Valve Sparing ◽

Aortic Valve Reimplantation

Background. Aortic valve-sparing operations are one of the relatively new approaches for treatment of patients with aortic root aneurysm and aortic valve insufficiency, but nowadays the common treatment strategy is absent. Methods. We studied the short-term results of David I valve-sparing operations in 19 patients with aortic root aneurysms and aortic insufficiency. Results. There were no lethal cases observed. 3 patients had mild aortic regurgitation, the majority of patients had no or trace aortic insufficiency. The significant decrease of left ventricle sizes was shown. Conclusions. The David I technique of aortic valve reimplantation seems to be optimal in patients with aortic root aneurysm, aortic insufficiency and normal aortic cusps.

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Aortic valve reimplantation by using a Kuban Cuff technique in patients with ascending aorta aneurysm and aortic insufficiency

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-2-17-25 ◽

2016 ◽

Vol 20 (2) ◽

pp. 17

Author(s):

S. Yu. Boldyrev ◽

O. A. Rossokha ◽

K. O. Barbukhatti ◽

V. A, Porkhanov

Keyword(s):

Aortic Valve ◽

Circulatory Arrest ◽

Postoperative Bleeding ◽

Aortic Insufficiency ◽

Ascending Aorta ◽

Vascular Prostheses ◽

Aorta Aneurysm ◽

Bentall Procedure ◽

The Mean ◽

Aortic Valve Reimplantation

Aim: This study was designed to evaluate the results of using a new method of aortic valve reimplantation named Kuban Cuff technique, where the key stage of surgery was to create new sinuses of Valsalva. Methods: Analyzed over a period from 2011 to 2015 were the outcomes of treatment of 45 (37 males) patients with various anatomy of the aortic valve (tri/bicuspid ones) and initial pathologies: aneurysms of the root and the ascending aorta, dissection of the ascending aorta, insufficiency of the aortic valve. A detailed description of the surgical technique and the unique device to prepare a vascular graft for reimplantation is given. The mean age of patients was 56.5 years (46.5; 66.5), the average time of cardiopulmonary bypass was 193.6 min (128.9; 258.2), the aorta cross-clamping time was 142.6 min (104.5; 180.7), the circulatory arrest time was 28.1 min (13.1; 43.1). Results: Hospital mortality was 2 (4.4%) patients. 3 (6.6%) patients underwent re-sternotomy because of postoperative bleeding. One patient had to undergo a redo (Bentall procedure) at 2 months after discharge from the hospital as a result of acute infective endocarditis of the aortic valve. All patients demonstrated a good function of the aortic valve with regurgitation of 0/1 grade. Prior to discharge, the aortic regurgitation grade was decreased from 2.83±0.44 before surgery to 0.62±0.7 after surgery. The mean follow-up time in 42 patients (93.3%) was 12.3 months (2.68; 21.98). Conclusions: The Kuban Cuff technique fully recreates a close analogue of the natural aortic root, stabilizes the fibrous annulus of the aortic valve, minimizes the risk of bleeding from the anastomosis zone. The technique is simple and reproducible with any type of vascular prostheses and does not take much time.

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Subcapsular hepatic hematoma as a complicating cardiac surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211069187 ◽

2021 ◽

pp. 021849232110691

Author(s):

Shintaro Takago ◽

Satoru Nishida ◽

Yukihiro Noda ◽

Toru Yamamoto

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Aortic Valve ◽

Ascending Aorta ◽

Aortic Valve Insufficiency ◽

Ascending Aortic Aneurysm ◽

Hepatic Hematoma ◽

Valve Insufficiency ◽

Aorta Replacement ◽

Ascending Aorta Replacement

An 80-year-old woman was hospitalized for aortic valve insufficiency, paroxysmal atrial fibrillation, and ascending aortic aneurysm. She underwent aortic valve replacement, pulmonary vein isolation, left atrium appendectomy, and ascending aorta replacement. She developed a subcapsular hepatic hematoma during the surgery. The patient was managed conservatively and discharged successfully.

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Computed tomography angiography findings predict the risk factors for preoperative acute ischaemic stroke in patients with acute type A aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz351 ◽

2020 ◽

Vol 57 (5) ◽

pp. 912-919 ◽

Cited By ~ 2

Author(s):

Hongliang Zhao ◽

Wanling Ma ◽

Didi Wen ◽

Weixun Duan ◽

Minwen Zheng

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Aortic Valve ◽

False Lumen ◽

Ascending Aorta ◽

Acute Type ◽

Aortic Valve Insufficiency ◽

True Lumen ◽

Type A Aortic Dissection ◽

Valve Insufficiency

Abstract OBJECTIVES Acute ischaemic stroke (AIS) is a highly dreaded complication of acute type A aortic dissection (ATAAD). Knowledge about independent predictors of preoperative AIS in patients with ATAAD remains unclear. The aim of this study was to identify the risk factors for preoperative AIS in patients with ATAAD by computed tomography angiography (CTA) findings. METHODS Between October 2014 and March 2017, 281 (217 male; mean age, 50 years) patients with ATAAD underwent aortic CTA and diffusion-weighted magnetic resonance imaging of the brain was used to confirm the results. The clinical data and CTA findings were evaluated retrospectively. Patients were divided into 2 groups depending on the presence or absence of preoperative AIS. RESULTS Preoperative AIS was detected in 103 (36.7%) of the patients with ATAAD. Univariable analysis of the clinical characteristics and CTA findings revealed that age, aortic valve insufficiency (moderate or severe), the ratio of the diameter of the true lumen of the ascending aorta to the diameter of the involved ascending aorta, intimal flap plaque, dissection of the common carotid artery (CCA), the lower density of the unilateral internal carotid artery, the CCA originating from the false lumen and dissection of the subclavian artery were implicated in patients with ATAAD with AIS. Multivariable analysis further showed that aortic valve insufficiency (moderate or severe) [odds ratio (OR) 2.033, 95% confidence interval (CI) 1.052–3.931; P = 0.035], 2 CTA findings including the ratio of the diameters (OR 0.074, 95% CI 0.011–0.516; P = 0.009) and dissection of the CCA (OR 2.422, 95% CI 1.389–4.224; P = 0.002) were independent risk predictors for preoperative AIS in patients with ATAAD. The lower density in the false lumen, the same enhancement in the true and false lumen with re-entry and the stenosis of the true lumen without re-entry significantly increased the risk of preoperative AIS in CCA dissection. CONCLUSIONS Aortic valve insufficiency (moderate or severe), the ratio of the diameters of the true and false lumens and CCA dissection are independent predictors of preoperative AIS in patients with ATAAD. The specific carotid and aortic CTA findings may help to predict the risk factors for preoperative AIS in patients with ATAAD. Clinical registration number 20120216-4.

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