Valve-sparing operation for aortic coaptation/Valve-sparing operation for ascending aorta aneurysm

2012 ◽  
Author(s):  
Sahin Bozok ◽  
Mert Kestelli ◽  
Gokhan Ilhan
Keyword(s):  
Ascending Aorta ◽  
Aorta Aneurysm ◽  
Valve Sparing

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

Early safety performance of a modified technique of aorta replacement with sinotubular stabilization

2021 ◽  
pp. 021849232110150
Author(s):  
Marco Moscarelli ◽  
Nicola Di Bari ◽  
Giuseppe Nasso ◽  
Khalil Fattouch ◽  
Thanos Athanasiou ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Safety Performance ◽  
Modified Technique ◽  
Sinotubular Junction ◽  
Aorta Replacement ◽  
Valve Sparing ◽  
Ascending Aorta Replacement

Background We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. Methods This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dilatation of the ascending aorta, normal sinuses of Valsalva dimension (<45 mm), with or without aortic annulus enlargement (>25 mm) and with various degree of aortic insufficiency (from grade 1 to 3). Results From April to October 2019, 20 patients were recruited from two centers; mean age was 66.9 ± 12.8 years, 13 were male; grade 1, 2 and 3 was present in 12, 2 and 6 patients, respectively. All patients underwent ascending aorta replacement with modified technique; an additional open subvalvular ring was used in 8 patients with aortic insufficiency ≥ 2; cusps repair was performed in 6 patients (5 plicating central stitches/1 shaving); concomitant coronary artery bypass grafting was performed in 10 patients. There was no 30-day mortality. One patient was re-explored for bleeding. All patients completed six-month follow-up; at the transthoracic echocardiography, there was no aortic insufficiency ≥ 1 except one patient with aortic insufficiency grade 1 who underwent ascending aorta replacement and subvalvular ring; no patients underwent reintervention. Conclusions This modified technique for ascending aorta replacement and sinotubular junction stabilization was safe. It could be associated with other aortic valve sparing techniques. However, such remodeling approach has to be validated in a larger cohort of patients with longer follow-up.

Molecular structure analysis of ascending aorta aneurysm upon atherosclerosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Mamarelis ◽  
V Mamareli ◽  
M Kyriakidou ◽  
O Tanis ◽  
C Mamareli ◽  
...  
Keyword(s):  
Molecular Structure ◽  
Raman Spectra ◽  
Molecular Level ◽  
Ascending Aorta ◽  
Ir And Raman Spectra ◽  
Aggregate Formation ◽  
Aorta Aneurysm ◽  
Ft Ir ◽  
Molecular Structure Analysis ◽  
Ir And Raman

Abstract Background The atherosclerotic ascending aorta could represent a potential source of emboli or could be an indicator of atherosclerosis in general with high mortality. The mechanism of aneurysm formation and atherosclerosis of the ascending aorta at the molecular level has not yet been clarified. To approach the mechanism of ascending aortic lesions and mineralization at a molecular level, we used the non-destructive FT-IR, Raman spectroscopy, SEM and Hypermicroscope. Methods Six ascending aorta biopsies were obtained from patients who underwent aortic valve replacement (AVR) cardiac surgery. CytoViva (einst inc) hyperspectral microscope was used to obtain the images of ascending aorta. The samples were dissolved in hexane on a microscope glass plate. The FT-IR and Raman spectra were recorded with Nicolet 6700 thermoshintific and micro-Raman Reinshaw (785nm, 145 mwatt), respectively. The architecture of ascending aorta biopsies was obtained by using scanning electron microscope (SEM of Fei Co) without any coating. Results FT-IR and Raman spectra showed changes arising from the increasing of lipophilic environment and aggregate formation (Fig. 1). The band at 1744 cm–1 is attributed to aldehyde CHO mode due to oxidation of lipids. The shifts of the bands of the amide I and amide II bands to lower are associated with protein damage, in agreement with SEM data. The bands at about 1170–1000 cm–1 resulted from the C-O-C of advanced glycation products as result of connecting tissues fragmentations and polymerization. The spectroscopic data were analogous with the lesions observed with SEM and hypermicroscopic images. Conclusions The present innovate molecular structure analysis showed that upon ascending aorta aneurysm development an excess of lipophilic aggregate formation and protein lesions, changing the elasticity of the aorta's wall. The released Ca2+ interacted mostly with carbonate-terminal of cellular protein chains accelerated the ascending aorta calcifications. Figure 1. FT-IR and Raman spectra Funding Acknowledgement Type of funding source: None

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 Oxidative Stress Inside the Pathogenesis of Ascending Aorta Aneurysms: A Clearer Vision for Identifying Promising Biomarkers and Therapeutic Targets

2021 ◽  
Author(s):  
Carmela Balistreri ◽  
Calogera Pisano ◽  
Giovanni Ruvolo
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Genetic Variants ◽  
Complex Disease ◽  
Ascending Aorta ◽  
Oxygen Species ◽  
Aorta Aneurysm ◽  
Independent Risk Factors ◽  
The Impact ◽  
And Oxidative Stress

Ascending aorta aneurysm (AsAA) is a complex disease, currently defined an inflammatory disease. In the sporadic form, AsAA has, indeed, a complex physiopathology with a strong inflammatory basis, significantly modulated by genetic variants in innate/inflammatory genes, acting as independent risk factors and as largely evidenced in our recent studies performed during the last 10 years. Based on these premises, here, we want to revise the impact of reactive oxygen species (ROS) and oxidative stress on AsAA pathophysiology and consequently on the onset and progression of sporadic AsAA. This might consent to add other important pieces in the intricate puzzle of the pathophysiology of this disease with the translational aim to identify biomarkers and targets to apply in the complex management of AsAA, by facilitating the AsAA diagnosis currently based only on imaging evaluations, and the treatment exclusively founded on surgery approaches.

scholarly journals Giant Aortic Aneurysm in Child with Cutis Laxa Syndrome: Unusual Presentation, New Surgical Technique

2021 ◽  
Vol 24 (6) ◽  
pp. E1054-E1056
Author(s):  
Mazen Shamsaldeen Faden ◽  
Nada Ahmed Noaman ◽  
Osman Osama Osman Osama ◽  
Ahmed Abdelrahman Elassal ◽  
Arwa Mohammed Al-ghamdi ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
Ascending Aorta ◽  
Accurate Diagnosis ◽  
Aortic Aneurysms ◽  
Cutis Laxa ◽  
Descending Aorta ◽  
Aorta Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Valvular Insufficiency ◽  
New Surgical Technique

Ascending thoracic aortic aneurysms are rare in childhood and typically are seen in the setting of connective tissue defect syndromes. These aneurysms may lead to rupture, dissection, or valvular insufficiency, so root replacement is recommended. Here, we present a 17-month-old girl who presented with fever, cough, and pericardial effusion. Initially, we suspected this could be a COVID-19 case, so a nasopharyngeal swap was performed. An ascending aorta aneurysm involving the aortic arch was confirmed by echo, and urgent ascending aorta and arch replacement were done by utilizing the descending aorta as a new arch. The final diagnosis came with cutis laxa syndrome. In similar cases, good outcomes can be achieved with accurate diagnosis and appropriate surgical management.

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

Acute Type A Aortic Dissection After TAVR in an Octogenarian With Ascending Aorta Aneurysm

2021 ◽  
Author(s):  
Helen Hashemi ◽  
Sahil Khera ◽  
Malcolm Anastasius ◽  
Ismail El-Hamamsy ◽  
Gilbert H.L. Tang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aorta Aneurysm

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.

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