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

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.

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High Failure Rate After Valve-sparing Aortic Root Replacement Using the “Remodeling Technique” in Acute Type A Aortic Dissection

Circulation ◽

10.1161/01.cir.0000032850.20885.9b ◽

2002 ◽

Vol 106 (12_suppl_1) ◽

Author(s):

Rainer G. Leyh ◽

Stefan Fischer ◽

Klaus Kallenbach ◽

Theo Kofidis ◽

Klaus Pethig ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Root ◽

Type A ◽

Aortic Root Replacement ◽

Acute Type ◽

Type A Aortic Dissection ◽

Acute Type A Dissection ◽

Type A Dissection ◽

Valve Sparing

Background Valve-sparing surgery including the replacement of the sinus of valsalvae were initially meant to be promising approaches in the treatment of acute type A aortic dissection. However, the long-term outcome after valve-sparing aortic root replacement in acute type A dissection is currently the subject of intense debate, and the evidence reported in the literature is sparse. Here we report on our experience on valve sparing aortic root replacement inpatients with acute type A dissection. Methods From August 1995 to November 2000, 30 patients with acute type A dissection received valve-sparing aortic root replacement. Two different techniques were performed: the “remodeling” technique, first described by Yacoub in 1983 (8 patients) and the “reimplantation” technique, initially described by David and Feindel, in 1992 (22 patients). Endpoints of the study were early and late mortality, as well as aortic valve-related complications and reoperations. Results The mean follow-up time was 22.6±15.4 months. The overall 30 day mortality was 17% (5/29) and the late mortality 4% (1/24). During the observation period, 4 patients had to be reoperated (n=3) for acute aortic valve regurgitation after aortic root remodeling and for acute aortic valve endocarditis (n=1) after aortic root reimplantation. In the 3 patients with acute aortic valve regurgitation, symptoms occurred 44, 24, and 17 months after the initial operation in these patients. Intraoperatively prolapsing aortic leaflets because of commissural detachment was found in all 3 cases. In all other patients the latest echocardiographic follow-up examination revealed freedom from aortic regugitation higher than grade 1. Conclusions The high failure rate of aortic root remodeling inpatients with acute type A aortic dissection is discouraging. Whether this technique should be applied in acute type A aortic dissection is questionable. In contrast, aortic root reimplantation lead to favorable midterm outcome. Thus, we recommend consideration of this technique for surgical treatment of patients with acute type A aortic dissection.

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Durable results of preserved valve and root after acute type A aortic dissection surgery in bicuspid aortic valve

10.22541/au.164122826.65688937/v1 ◽

2022 ◽

Author(s):

Tsu-Jui Hsu ◽

Cheng-Wei Chen ◽

Ron-Bin Hsu

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Valve Replacement ◽

Bicuspid Aortic Valve ◽

Emergency Surgery ◽

Type A ◽

Long Term Results ◽

Acute Type ◽

Type A Aortic Dissection

Background and aims of the study. Data on emergency surgery for acute type A aortic dissection in patients with bicuspid aortic valve were limited. Long-term results on the fate of the preserved bicuspid valve and aortic root were even rare. We sought to assess the clinical outcome of emergency acute type A aortic dissection surgery in patients with bicuspid aortic valve. Methods. From 2004 to 2021, 121 patients underwent emergency surgery for acute type A aortic dissection using a conservative aortic resection. Hospital and late outcomes were assessed in patients with bicuspid aortic valve. Results. Eight patients (6.6%) had bicuspid aortic valve with 6 males (75%) and median age of 49.5 years (range, 34 to 71). Four (50%) had significant aortic valve dysfunction. Operation included ascending aortic grafting with aortic valve preservation in 4, ascending aortic grafting with aortic valve replacement in 3 and ascending aortic grafting with Bentall root replacement in 1. Hospital mortality rate was 12.5% (1/8). With a median follow-up of 14.4 years, there was one late death and no proximal reoperation of 6 preserved roots and 3 preserved valves. Median diameter of preserved aortic roots changed from 42 (range, 33-43) to 38.5 mm (range, 35-46) with the average time of 11 years after surgery. Conclusions. Acute type A aortic dissection in bicuspid aortic valve was not associated with worse outcome. Aortic valve replacement was often required. Simultaneous root replacement was not always necessary. Preservation of normally functioning bicuspid valve and non-dilated root showed durable long-term results.

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Reported outcomes after aortic valve resuspension for acute type A aortic dissection: a systematic review and meta-analysis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz080 ◽

2019 ◽

Vol 29 (3) ◽

pp. 331-338

Author(s):

Shuang-Kun Chen ◽

Zhi-Huang Qiu ◽

Guan-Hua Fang ◽

Xi-Jie Wu ◽

Liang-Wan Chen

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Root ◽

Meta Analysis ◽

Type A ◽

Acute Type ◽

Aortic Valve Insufficiency ◽

Type A Aortic Dissection ◽

Valve Insufficiency

AbstractIn the majority of patients presenting with acute type A aortic dissection (AAD) complicated by aortic valve insufficiency, the aortic valve (AV) can be preserved by AV resuspension. A meta-analysis was performed to investigate the outcomes following AV resuspension for AAD. A systematic literature search for publications reporting outcomes after AV resuspension in AAD published between January 1998 and June 2018 was conducted. Early outcome events and linearized occurrence rates for late outcome events were derived. The retrieval process yielded 18 unique studies involving 3295 patients with a total of 17 532 patient-years (pt-yrs). Pooled early mortality was 15.5% [95% confidence interval (95% CI) 11.5–19.4%, I2 = 91.9%], and the linearized late mortality rate was 3.21%/pt-yrs (95% CI 2.49–3.77, I2 = 29%). The linearized occurrence rates for aortic root reintervention was 1.4%/pt-yrs (95% CI 0.88–1.79, I2 = 48%); for recurrent significant aortic valve insufficiency (>2+), it was 1.12%/pt-yrs (95% CI 0.79–1.45, I2 = 68%); and for endocarditis, it was 0.01%/pt-yrs (95% CI 0–0.04, I2 = 7%). The composite rate of thromboembolism and bleeding was 1.41%/pt-yrs (95% CI 0.18–2.63, I2 = 82%). A more recent surgical period was associated with a decreased hazard of reoperation on the aortic root (P < 0.001). Requirement of AV resuspension alone in AAD is a risk factor for mortality. The long-term durability of AV resuspension is excellent, with low rates of endocarditis and thromboembolism and bleeding. Root reoperation hazard has become acceptable in recent years. Preoperative aortic valve insufficiency grade exceeding 2+ is a predictor for root reoperation.

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

Aorta ◽

10.1055/s-0041-1725074 ◽

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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