valve reconstruction
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BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Xiaodong Wei ◽  
Tiange Li ◽  
Yunfei Ling ◽  
Zheng Chai ◽  
Zhongze Cao ◽  

Abstract Background Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. Pulmonary regurgitation is the most common and severe comorbidity after transannular patch (TAP) repair of TOF patients. It has not been confirmed whether a TAP repair with monocusp valve reconstruction would benefit TOF patients in perioperative period compared to those without monocusp valve reconstruction. The purpose of the study is to review and analyze all clinical studies that have compared perioperative outcomes of TOF patients undergoing TAP repair with or without monocusp valve reconstruction and conduct a preferable surgery. Methods Eligible studies were identified by searching the electronic databases. The year of publication of studies was restricted from 2000 till present. The primary outcome was perioperative mortality, and secondary outcomes included cardiopulmonary bypass time, aortic cross-clamp time, ventilation duration, ICU length of stay, hospital length of stay, perioperative right ventricular outflow tract (RVOT) pressure gradient, and moderate or severe pulmonary regurgitation (PR). The meta-analysis and forest plots were drawn using Review Manager 5.3. Statistically significant was considered when p-value ≤ 0.05. Results Eight studies were included which consisted of 8 retrospective cohort study and 2 randomized controlled trial. The 10 studies formed a pool of 526 TOF patients in total, in which are 300 undergoing TAP repair with monocusp valve reconstruction (monocusp group) compared to 226 undergoing TAP repair without monocusp valve reconstruction (non-monocusp group). It demonstrated no significant differences between two groups in perioperative mortality (OR = 0.69, 95% CI 0.20–2.41, p = 0.58). It demonstrated significant differences in perioperative cardiopulmonary bypass time (minute, 95% CI 17.93–28.42, p < 0.00001), mean length of ICU stay (day, 95% CI − 2.11–0.76, p < 0.0001), and the degree of perioperative PR (OR = 0.03, 95% CI 0.010.12, p < 0.00001). Significant differences were not found in other secondary outcomes. Conclusion Transannular patch repair with monocusp valve reconstruction have significant advantages on decreasing length of ICU stay and reducing degree of PR for TOF patients. Large, multicenter, randomized, prospective studies which focuse on perioperative outcomes and postoperative differences based on long-term follow-up between TAP repair with and without monocusp valve reconstruction are needed.

2021 ◽  

Replacements for diseased aortic valves are limited. Repair of the aortic valve is performed by only a few surgeons. A novel technique of aortic valve reconstruction using autologous pericardium shows promising results. In this video tutorial, we demonstrate the Ozaki procedure using an ex vivo low fidelity simulation.

Giuseppe Speziale ◽  
Giuseppe Santarpino ◽  
Marco Moscarelli ◽  
Nicola Di Bari ◽  
Flavio Fiore ◽  

Thanh Hung Ngo ◽  
Cong Huu Nguyen ◽  
Duc Thinh Do ◽  
Hoang Long Luong ◽  
Thao Nguyen Phan ◽  

Objective: The study aimed to evaluate the indications and describe the aortic valve reconstruction techniques by Ozaki’s procedure in Vietnam and report mid-term outcomes of this technique in Vietnam. Methods: Between June 2017 and December 2019, 72 patients diagnosed with isolated aortic valve disease, with a mean age of 52.9 (19 – 79 years old), and a male:female ratio of 3:1 underwent aortic valve reconstruction surgery by Ozaki’s technique at Cardiovascular Center, E Hospital, Vietnam. Results: The aortic valve diseases consisted of aortic stenosis (42%), aortic regurgitation (28%), and a combination of both (30%). In addition, the proportion of aortic valves with bicuspid morphology and small annulus (≤ 21 mm) was 28% and 38.9%, respectively. The mean aortic cross-clamp time was 106 ± 13.8 minutes, mean cardiopulmonary bypass time was 136.7 ± 18.5 minutes, and 2.8% of all patients required conversion to prosthetic valve replacement surgery. The mean follow-up time was 26.4 months (12- 42 months), the survival rate was 95.8%, the reoperation rate was 2.8%, and rate of postoperative moderate or higher aortic valve regurgitation was 4.2%. Postoperative valvular hemodynamics was favorable, with a peak pressure gradient of 16.1 mmHg and an effective orifice area index of 2.3 cm . Conclusions: This procedure was safe and effective, with favorable valvular hemodynamics and a low rate of valvular degeneration. However, more long-term follow-up data are needed.

2021 ◽  
Kazuma Handa ◽  
Takafumi Masai ◽  
Toshihiro Ohata ◽  
Tomohiko Sakamoto ◽  
Toru Kuratani

Abstract Objective: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods: Five patients (50 ± 30 years of age; 3 men, 2 women) underwent this procedure from January 2011 to December 2020. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 70% ± 5%). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC.Results: The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 35 ± 5 days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The mean follow-up period was 7.2 (range, 1.3–9.5) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions: The short- and long-term outcomes of this procedure were satisfactory. This procedure might be considered as an effective and valuable option, especially in young patients.

2021 ◽  
Vol 25 (3) ◽  
pp. 106
R. N. Komarov ◽  
A. O. Simonyan ◽  
I. A. Borisov ◽  
V. V. Dalinin ◽  
A. M. Ismailbaev ◽  

<p>Various types of autologous materials are used in heart valve surgery, particularly the aortic valve, and this article describes their historical development. The evolution of the use of various autogenous tissues, such as the aortic wall, fascia lata of the thigh, pericardium and others is described and discussed in detail. This paper presents the results of experimental and clinical publications devoted to the surgical techniques and the outcomes of heart valve reconstruction using such materials. The negative aspects of the use of a wide range of autografts are discussed, including the short service life and low strength, which led to declining interest in this group of reconstructive interventions. The method for treating the autopericardium with glutaraldehyde, proposed in 1986 by C.S. Love, J.W. Love and colleagues, raised the use of autologous materials in the reconstruction of heart valves to a new level, allowing surgeons to strengthen the autopericardial flaps and increase resistance to hemodynamic stress. Many surgeons, their interest in such treatment methods increased by this discovery, then reported their observations and further developed ways of using the treated autopericardium in aortic valve surgery. Particularly, the method of neocuspidisation of the aortic valve, introduced into wide practice by M.G. Duran and S. Ozaki, has become the quintessential reconstructive valve surgery involving the use of autologous materials.</p><p>Received 14 March 2021. Revised 26 April 2021. Accepted 27 April 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: A.O. Simonyan, A.M. Ismailbaev<br />Drafting the article: A.O. Simonyan, A.M. Ismailbaev, N.O. Kurasov, M.I. Tcheglov<br />Critical revision of the article: R.N. Komarov, V.V. Dalinin, I.A. Borisov<br />Final approval of the version to be published: R.N. Komarov, A.O. Simonyan, I.A. Borisov, V.V. Dalinin, A.M. Ismailbaev, N.O. Kurasov, M.I. Tcheglov</p>

Sivakumar Sivalingam ◽  
Maruti Haranal ◽  
Iqbal Hussain Pathan

Abstract OBJECTIVES Different methods of aortic valve repair have been described in the literature for aortic regurgitation (AR) associated with doubly committed subarterial ventricular septal defects. Our goal was to present our experience with aortic valve reconstruction of a single leaflet using the aortic valve neocuspidization technique in this subset of patients. METHODS It is a retrospective review of 7 patients with doubly committed subarterial ventricular septal defects with significant (&gt;moderate) AR who underwent the single-leaflet neocuspidization technique of aortic valve reconstruction from January 2016 to January 2019. Data were collected from medical records. All patients had thorough 2-dimensional echocardiographic assessment preoperatively and during the follow-up period. Primary end points were freedom from postoperative AR and freedom from reoperation and all-cause mortality within the follow-up period with secondary end points of freedom from thromboembolism and infective endocarditis. RESULTS Out of 7 patients, 6 were male and 1 was female. There were no perioperative deaths. The mean follow-up period was 2.6 ± 0.8 years. No deaths occurred during the follow-up period. At the latest follow-up examination, only 2 patients showed mild AR and were asymptomatic. There was no documented event of infective endocarditis or thromboembolism during the follow-up period. CONCLUSIONS The aortic leaflet neocuspidization procedure for the aortic valve is a relatively new concept. Availability of a template makes it an easily reproducible valve repair in paediatric patients with a single-leaflet abnormality. This technique preserves the remaining 2 normal leaflets, thus promoting the growth potential while maintaining near normal aortic root complex dynamics.

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