scholarly journals Bentall–De Bono procedure for aortic regurgitation and intraoperative rupture of moderately dilated ascending aorta: A case report

2021 ◽  
Vol 25 (4) ◽  
pp. 106
Author(s):  
S. Yu. Boldyrev ◽  
M. A. Marukyan ◽  
V. N. Suslova ◽  
K. O. Barbukhatti ◽  
V. A. Porkhanov
Keyword(s):  
Aortic Valve ◽  
Histological Examination ◽  
Conflict Of Interest ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Aortic Dilatation ◽  
Aggressive Approach ◽  
Aortic Replacement ◽  
Valve Insufficiency ◽  
Enhanced Computed Tomography

<p>We herein present a clinical case of root and ascending aortic replacement in a patient with borderline enlargement of the ascending aorta and aortic valve insufficiency. A 65-year-old man was admitted to our clinic with signs of heart failure. Subsequent echocardiography and contrast-enhanced computed tomography revealed hemodynamically significant aortic insufficiency, as well as expansion of the ascending aorta. Diameter at the levels of the sinuses of Valsalva, sinotubular junction and tubular portion of the ascending aorta were 48, 47 and 44 mm, respectively. Based on the aforementioned data, indications for isolated aortic valve replacement were determined. Although the main portion of the surgery was unremarkable, at its final stage, a rupture of a section of the ascending aorta occurred. The results of intraoperative express histological examination of the enlarged aorta revealed connective tissue dysplasia and cystic median necrosis. Replacement of the ascending aorta was performed using the modified Bentall–De Bono technique. This case demonstrated that a borderline aortic dilatation of 40–50 mm at the ascending aorta was associated with pathological changes in its wall, which can cause fatal complications (rupture and dissection) and may require a more aggressive approach during surgical correction. Intraoperative express histological examination of the wall of the ascending aorta in ambiguous situations can help determine the scope of the intervention.</p><p>Received 16 March 2021. Revised 14 September 2021. Accepted 15 September 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: S.Yu. Boldyrev, M.A. Marukyan<br /> Drafting the article: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova<br /> Critical revision of the article: S.Yu. Boldyrev, V.A. Porkhanov<br /> Surgical treatment: S.Yu. Boldyrev, M.A. Marukyan<br /> Final approval of the version to be published: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova, K.O. Barbukhatti, V.A. Porkhanov</p>

scholarly journals Aortic root reimplantation procedure: a new milestone in aortic valve-sparing operations

2016 ◽  
Vol 20 (2) ◽  
pp. 49
Author(s):  
A. M. Chernyavskiy ◽  
D. S. Khvan ◽  
S. A. Alsov ◽  
D. A. Sirota ◽  
M. M. Lyashenko
Keyword(s):  
Aortic Valve ◽  
Conflict Of Interest ◽  
Aortic Root ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Long Term Follow Up ◽  
Valve Sparing ◽  
Reimplantation Procedure

<p><strong>Aim:</strong> Emphasis in this study was placed on clinical and functional assessment of a modified "Florida Sleeve" procedure during surgical correction of ascending aorta aneurysms with concomitant aortic insufficiency.<br /><strong>Methods:</strong> 32 patients with an aneurysm of the ascending aorta and aortic insufficiency underwent a modified "Florida Sleeve" procedure. The average follow-up was 17 (0-60) months. The average age of patients was 57±13 (23-73) years 56±13 years.<br /><strong>Results:</strong> The expected 4-year cumulative survival rate was 84.3%. Overall freedom from aortic insufficiency in the late period was 88.9%. Median aortic regurgitation was 1+ (1; 2). Long-term follow-up revealed no valve-associated complications.<br /><strong>Conclusion:</strong> The aortic root reimplantation procedure enables optimal correction of the existing lesions of the aortic root without performing aortic valve replacement and demonstrates stable clinical and functional outcomes in the long-term period.</p><p><strong>Key words:</strong> aortic aneurysm; aortic valve; valve-sparing operations.</p><p><strong>Funding</strong></p><p>The study had no sponsorship.</p><p><strong>Conflict of interest</strong></p><p>The authors declare no conflict of interest.</p>

scholarly journals Sutureless aortic valve with supracoronary ascending aortic replacement as an alternative strategy for composite graft replacement in elderly patients

2021 ◽  
Author(s):  
J. R Olsthoorn ◽  
K. Y. Lam ◽  
F. Akca ◽  
N. M. A. J. Timmermans ◽  
M. E. S. H. Tan
Keyword(s):  
Aortic Valve ◽  
Aortic Surgery ◽  
Composite Graft ◽  
Ascending Aorta ◽  
Alternative Strategy ◽  
Aortic Dilatation ◽  
Valve Prosthesis ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Pathology

AbstractAortic valve disease is frequently associated with ascending aorta dilatation and can be treated either by separate replacement of the aortic valve and ascending aorta or by a composite valve graft. The type of surgery is depending on the exact location of the aortic dilatation and the concomitant valvular procedures required. The evidence for elective aortic surgery in elderly high-risk patients remains challenging and therefore alternative strategies could be warranted. We propose an alternative strategy for the treatment of ascending aortic aneurysm and aortic valve pathology with the use of a sutureless, collapsible, stent-mounted aortic valve prosthesis.

scholarly journals Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency

2016 ◽  
Vol 20 (2) ◽  
pp. 35 ◽  
Author(s):  
M. L. Gordeev ◽  
V. E. Uspenskiy ◽  
G. I. Kim ◽  
A. N. Ibragimov ◽  
T. S. Shcherbinin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Type A ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

<p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br /><strong>Methods:</strong> From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.<br /><strong>Results:</strong> The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.<br /><strong>Conclusions:</strong> Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.</p><div class="well well-small"><strong>Funding</strong></div><p><strong></strong> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies.<br /><strong></strong></p><p><strong>Conflict of interest</strong></p><p><strong></strong>The authors declare no conflict of interest.</p><p><strong>Acknowledgement</strong></p><p>The authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology &amp; Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.</p>

Ascending Aortic Replacement With Aortic Valve Reimplantation

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Wolfgang Harringer ◽  
Klaus Pethig ◽  
Christian Hagl ◽  
Gerd P. Meyer ◽  
Axel Haverich
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Additional Patient ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Ischemic Attack ◽  
Aortic Valve Reimplantation

Background —Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft in patients with aortic root aneurysms corrects annular ectasia and dilatation of the sinotubular junction. The durability of this valve repair with respect to the increased mechanical stress on valve cusps has been discussed, is quite controversial, and is yet unknown. Methods and Results —From July 1993 to November 1998, a replacement of the ascending aorta with a repair of the aortic valve was performed in 75 patients (53 men and 22 women aged 50±19 years). Twenty-one patients (28%) had Marfan syndrome, and 11 patients (15%) had an aortic dissection, type Stanford A (6 acute, 5 chronic). In 17 patients (23%), concomitant replacement of the aortic arch was necessary. Clinical and echocardiographic follow-up was performed in 6- to 12-month intervals for a cumulative study period of 137 patient-years. No operative deaths occurred. Two patients (3%) died 5 and 20 months postoperatively. One additional patient experienced a transient ischemic attack within the first postoperative week. Three patients (4%) with progressive aortic insufficiency required aortic valve replacement after 9, 11, and 14 months. All other patients had no or mild aortic insufficiency. The repairs have now remained stable for ≤65 months (mean, 22±20 months). Other valve-related complications did not occur. Conclusions —Our results demonstrate that this type of aortic valve repair achieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace aortic insufficiency at initial echocardiography seems to be essential for durability.

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 Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification†

2019 ◽  
Vol 56 (2) ◽  
pp. 351-359 ◽  
Author(s):  
Laurent de Kerchove ◽  
Stefano Mastrobuoni ◽  
Lennart Froede ◽  
Saadallah Tamer ◽  
Munir Boodhwani ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Classification System ◽  
Type A ◽  
Aortic Insufficiency ◽  
Aortic Dilatation ◽  
Valve Repair ◽  
Type C ◽  
Anatomical Parameters ◽  
Repair Techniques

AbstractOBJECTIVESThe bicuspid aortic valve (BAV) exists in a wide variety of valve phenotypes. The aim of this study was to assess the anatomical characteristics of the different phenotypes and develop a classification system to aid surgical repair.METHODSIn 178 consecutive patients operated on for aortic insufficiency or aortic dilatation in 2 centres, 11 anatomical parameters of BAV were measured by echocardiography and intraoperatively. All BAV judged potentially repairable were included in the study.RESULTSCommissural orientation correlated positively with fusion length (R2 = 0.6, P < 0.001) and negatively with non-functional commissure height (R2 = 0.45, P < 0.001). The cohort was divided into 3 groups according to their commissural orientation (type A: symmetrical, 160–180°, n = 73; type B: asymmetrical, 140–159°, n = 74; and type C: very asymmetrical, 120–139°, n = 31). The patterns of cusp fusion, annulus and aortic size were similar among the groups. Fusion length and the geometric height of the cusps decreased from type A to C; non-functional commissure height increased from type A to C (P < 0.05). Patient age increased from type A to type C. Isolated aortic dilatation was more frequent in type A, and severe aortic insufficiency was more frequent in types B and C (P < 0.05). Valve repair techniques and management of commissural orientation varied among the 3 groups (P < 0.05). Aortic valve replacement and residual aortic insufficiency after repair were more frequent in type C (P < 0.05).CONCLUSIONSThe BAV phenotypes follow a continuous spectrum that extends from symmetrical to very asymmetrical BAV. We describe the main anatomical parameters (including commissure orientation, length of fusion and non-functional commissure height) and their variation across this spectrum. We propose a new repair-oriented classification system based on those parameters that can be used to predict valve repair techniques. This classification needs further validation with regards to surgical techniques and long-term outcomes.

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

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

<p><strong>Aim:</strong> 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.<br /><strong>Methods:</strong> 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).<br /><strong>Results:</strong> 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).<br /><strong>Conclusions:</strong> 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.</p>

scholarly journals Immediate Improvement in Severe Mitral Regurgitation After Aortic Valve Replacement for Severe Aortic Insufficiency

Aorta ◽  
2016 ◽  
Vol 04 (03) ◽  
pp. 91-94 ◽  
Author(s):  
Ahmad Zeeshan ◽  
Mojun Zhu ◽  
John Elefteriades
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Insufficiency ◽  
Functional Mitral Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Severe Aortic Regurgitation ◽  
Aortic Replacement

AbstractA 57-year-old male with ascending aortic aneurysm, severe aortic regurgitation, and severe mitral regurgitation (MR) underwent ascending aortic replacement and aortic valve replacement. MR in this patient with normal mitral valve morphology was considered secondary to aortic valve incompetency. Consequently, a surgical approach to restore aortic valve function was adopted with successful MR resolution. This case report demonstrates the possibility of reversing early functional mitral regurgitation without surgically approaching the mitral valve.

Abstract 3189: Prevalence of Bicuspid Aortic Valve in Turner Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Vandana Sachdev ◽  
Lea Ann Matura ◽  
Stanislav Sidenko ◽  
Vincent Ho ◽  
Andrew Arai ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Turner Syndrome ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Aortic Dilatation ◽  
Aortic Valves ◽  
Number Of Patients ◽  
Valve Structure ◽  
Asymptomatic Individuals

Women with Turner syndrome (TS) have an increased risk of congenital cardiovascular defects. Previous studies have reported a 10 –20% prevalence rate of bicuspid aortic valves and there are increasing reports of a vasculopathy that predisposes patients to aortic dilatation and dissection. This prospective study aimed to characterize aortic valve and aortic root structure in unselected asymptomatic individuals with TS. A total of 253 females aged 7– 67 years with karyotype proven TS were examined. Transthoracic echocardiography revealed a normal tricuspid aortic valve (TAV) in 162, a ‘probable TAV’ in 8 subjects, a bicuspid aortic valve (BAV) in 65 and ‘probable BAV’ in 3 subjects. The aortic valve could not be visualized by echocardiography in 15/253 or 6%. Magnetic resonance imaging (MRI) revealed valve structure in 11/12 of the probable cases (all confirmatory of the ‘probable’ diagnosis) and 12/15 of the non-visualized cases (8 BAV and 4 TAV), so only 3/253 subjects could not be visualized by either modality. The aortic valve was bicuspid in 76 of the 250 adequately imaged subjects (30%). Peak aortic valve flow was higher in BAV subjects (1.72±0.07 vs. 1.90v0.03 m/sec, P=0.0002), with one case of significant aortic stenosis. Among subjects with a BAV, aortic regurgitation was moderate or greater in ∼15%. Aortic diameters at the annulus, sinuses of Valsalva, sinotubular junction and ascending aorta were all significantly greater in the BAV group. Thirty patients in the BAV group (12%) had aortic root diameters that were outside of the 95% normal confidence limits based on Roman nomograms. Ascending aortic diameters by echo and MRI were highly correlated (r=0.77). In summary, echocardiography supplemented with MRI reveals an extraordinarily high prevalence of abnormal aortic valves in asymptomatic subjects with TS. The abnormal valve structure is associated with higher peak flows, evidence of clinically significant valvular dysfunction, and widening of the ascending aorta in a significant number of patients. All girls and women with TS should have careful echocardiographic evaluation upon diagnosis to identify the one in three asymptomatic individuals with an abnormal valve requiring monitoring for aortic root dilatation and valvular dysfunction.

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