Redo Bentall’s Procedure for Annuloaortic Ectasia with Severe Aortic Regurgitation: A Video Presentation (original) (raw)
Related papers
Aortic Regurgitation After Valve-Sparing Aortic Root Replacement: Modes of Failure
The Annals of Thoracic Surgery, 2011
Background. Despite the positive clinical results of valve-sparing aortic root replacement, little is known about the causes of reoperations and the modes of failure. Methods. From October 1999 to June 2010, 101 patients underwent valve-sparing aortic root replacement using the David reimplantation technique. The definition of aortic root repair failure included the following: (1) intraoperative conversion to the Bentall procedure; (2) reoperation performed because of aortic regurgitation; and (3) aortic regurgitation equal to or greater than a moderate degree at the follow-up. Sixteen patients were considered to have repair failure. Three patients required intraoperative conversion to valve replacement, 3 required reoperation within 3 months, and another 8 required reoperation during postoperative follow-up. At initial surgery 5 patients had moderate to severe aortic regurgitation, 6 patients had acute aortic dissections, 3 had Marfan syndrome, 2 had status post Ross operations, 3 had bicuspid aortic valves, and 1 had aortitis. Five patients had undergone cusp repair, including Arantius plication in 3 and plication at the commissure in 2. Results. The causes of early failure in 6 patients included cusp perforation (3), cusp prolapse (3), and severe hemolysis (1). The causes of late failure in 10 patients included cusp prolapse (4), commissure dehiscence (3), torn cusp (2), and cusp retraction (1). Patients had valve replacements at a mean of 23 ؎ 20.9 months after reimplantation and survived. Conclusions. Causes of early failure after valve-sparing root replacement included technical failure, cusp lesions, and steep learning curve. Late failure was caused by aortic root wall degeneration due to gelatin-resorcinformalin glue, cusp degeneration, or progression of cusp prolapse. (Ann Thorac Surg 2011;92:1639 -45) A lthough the indications for aortic valve-sparing operation for annulo-aortic ectasia have been expanded, some patients require reoperation because of recurrent or residual aortic regurgitation (AR) [1, 2]. This study aims to clarify the causes of AR after valve-sparing aortic root replacement. patients underwent aortic root replacement consisting of 98 valve-sparing operations, 41 Bentall operations and 17 stentless valve root replacements. In the 101 patients who had valve-sparing operations, the preoperative degree of AR was none to a trace in 4, mild in 26, moderate in 35, and severe in 36. The causes of AR included degenerative aortic cusp and wall disease in 59, Marfan syndrome in 24, acute aortic dissection in 18, bicuspid aortic valve in 12, aortitis in 4, and redo surgery in 10. Aortic root reimplantation (David) was performed in 100 patients; from July 2002 onward, Valsalva grafts were exclusively used. One patient had aortic root remodeling (Yacoub). The age at operation ranged from 13 to 75 years, with an average age of 49.7 Ϯ 15.9 years (65 men and 33 women).
Reimplantation versus aortic ring annuloplasty in bicuspid valve with borderline aortic root ectasia
JTCVS techniques, 2022
ObjectiveBicuspid aortic valve repair can be achieved with the reimplantation technique or external ring annuloplasty. Reimplantation could be an “overtreatment” in nonaneurysmatic aortic roots. External ring repair, on the contrary, could be an “undertreatment” in dilated roots. The aim of this retrospective study is to compare the 2 techniques in patients with borderline aortic root dimensions, analyzing early results, aortic regurgitation recurrence, and root dilation over time.MethodsWe selected patients with bicuspid aortic valve and ectasia of the aortic root (40-48 mm) who underwent reimplantation or external ring repair. We compared the 2 techniques, analyzing immediate postoperative and follow-up echocardiography. Only patients with at least 1 year of follow-up were included.ResultsWe obtained 2 groups of 21 patients (reimplantation) and 22 patients (external ring). Median follow-up time was 36 (40) months. There were no deaths during the follow-up periods. Three patients required reoperation in the external ring group because of recurrent aortic regurgitation, with a freedom from reoperation of 77.8% at 7 years (no reoperation was required in the reimplantation group). In the external ring group, we observed an immediate postoperative root diameter reduction and no significative expansion during follow-up (+0.4 mm/year, P = .184).ConclusionsExcellent results of reimplantation technique are confirmed and stable over time. Root diameter seems to remain stable over time when external ring technique was performed. The greater incidence of reoperation after external ring could be due to the progressive learning curve (256 patients vs 52 patients). Longer follow-up studies are needed.
Aortic root destruction after aortic valvuloplasty for bicuspid aortic valve
General Thoracic and Cardiovascular Surgery, 2020
Ultrasound cardiography showed severe aortic regurgitation (AR) due to bicuspid aortic valve with dilatation of the aortic annulus and sinotubular junction in a 27-year-old man hospitalized with loss of consciousness. He underwent aortic valvuloplasty combined with external suture annuloplasty using an expanded polytetrafluoroethylene (ePTFE) suture. Intraoperative findings revealed thickening and adhesion of the aortic root despite the first surgery. He developed recurrent AR 7 months later and underwent redo surgery. An ePTFE suture was found inside the aorta. Aortic root replacement with a mechanical composite graft was performed, as reconstruction appeared difficult because the aortic annulus was damaged and there were multiple holes on all cusps. Here, we report a rare case of aortic root destruction after external suture annuloplasty.
The Journal of Thoracic and Cardiovascular Surgery, 1999
Downloaded from ascending aorta. However, one of the major concerns regarding these operations is related to the mechanism of closure of the aortic valve leaflets. In both operative techniques, although aortic valve leaflet abrasion has not been reported as yet, we have echocardiographically documented that in some cases the aortic valve leaflets during systole are in contact with the rough texture of the Dacron tubular graft. In an attempt to minimize the potential problem of leaflet damage, we have recently developed a modified technique of aortic root reconstruction in which the native sinuses of Valsalva are preserved and remodeled. This report describes our experience with this modified technique.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012
We describe the treatment of an extremely rare case of interrupted aortic arch, annuloaortic ectasia, and aortic regurgitation in a 34-year-old man who presented with dyspnea and palpitation. We performed a single-stage operation involving aortic root reconstruction and valve repair with concomitant extra-anatomic bypass from the ascending to the descending aorta with a Dacron tube graft. The patient made a full recovery. To the best of our knowledge, this is the first such report in the English medical literature.
Interactive Cardiovascular and Thoracic Surgery, 2009
Objectives: Reimplantation valve-sparing aortic root replacement has been increasingly performed with improving perioperative and midterm results. The success of this operation primarily depends on preserving the highly sophisticated dynamic function of the aortic valve by recreating an anatomical three-dimensional configuration similar to the normal aortic root, thus minimizing the mechanical stress and strain on the cusps. Over the years several techniques have been proposed to reproduce the sinuses of Valsalva. We reviewed our experience with aortic valve reimplantation by means of a modified Dacron graft that incorporates sinuses of Valsalva, in a series of 100 consecutive patients. Methods: During a 60-month period, 100 patients with aortic root aneurysm underwent aortic valve reimplantation using the Gelweave Valsalvaீ prosthesis. There were 74 males and the mean age was 60"12 years (range 28-83 years). Five patients had the Marfan's syndrome, 15 had a bicuspid aortic valve. Cusp repair was performed in five patients. The mean follow-up time was 28.6 months (range 1-60). Transesophageal echocardiogram was performed at the end of each procedure to assess the aortic valve in terms of competence, dynamic motion and level of coaptation within the graft. Results: There was one hospital death and two late deaths. Overall survival at 60 months was 91.7"5.1%. Five patients developed severe aortic incompetence (AI) during follow-up requiring aortic valve replacement (AVR). The 60 months freedom from re-operation due to AI was 90.9"4.4%. One patient had moderate AI at latest echocardiographic study. The 60 months freedom from AI)2q was 91.6"7.9%. Cox regression identified cusp's repair as independent risk factor (Ps0.001) for late reimplantation failure (AVR or AI)2q). There were no episodes of endocarditis and the majority of the patients (88%) were in New York Heart Association functional class I. Conclusions: The aortic valve reimplantation with the Gelweave Valsalvaீ prosthesis provided satisfactory mid-term results. An accurate assessment of the level of coaptation of the aortic cusps in respect to the lower rim of the Dacron graft by means of intraoperative transesophageal echocardiogram at the end of each procedure is mandatory in order to avoid early reimplantation failure. Cusp's repair may play an important role in the development of late AI. However, long-term results are needed in order to define the durability of this technique.
Surgical repair of aortic root aneurysms in 280 patients
Annals of Thoracic Surgery, 1992
Bentall's technique for repair of annuloaortic ectasia has been associated with postoperative bleeding and with false aneurysms at the anastomotic site between the coronary orifices and valve-containing graft.
Annals of Thoracic Surgery, 2006
Background. Valve-sparing aortic root replacement for treatment of aortic sinus disease avoids the problems of prosthetic valves, but some patients suffer late valve incompetence as a result of leaflet distortion or annular dilatation. The reimplantation technique using the De Paulis Valsalva graft might improve late results of valvesparing aortic root replacement by maintaining annular stability and re-creating sinuses that minimize leaflet stress.
Twenty-seven-year experience with composite valve graft replacement of the aortic root
The Journal of heart valve disease, 2007
The study aim was to assess early and late outcome in patients undergoing composite valve graft replacement (CVGR) of the aortic root by means of the Bentall procedure, and to identify predictors of early and late death associated with this surgical approach. Between August 1975 and July 2002, 162 consecutive patients underwent a Bentall procedure for CVGR. Demographic, treatment and clinical outcome data from these patients were gathered, reviewed, and analyzed. Potential predictors of early and late mortality were analyzed. The study population was predominantly male (n = 132; 81.5%) and middle-aged (mean age 51.3 +/- 15.8 years; range: 10-79 years). The main indications for surgery were annuloaortic ectasia (n = 75; 46.3%), aortic dissection (n = 44; 27.2%) and Marfan syndrome (n = 34; 21%). Reoperation was required in 37 cases (22.8%). The mean follow up was 74 months. Early (in-hospital) mortality was 1.9% (n = 3). The only independent determinant of early mortality was cardiop...