Aortic Root Operations for Marfan Syndrome: A Comparison of the Bentall and Valve-Sparing Procedures

Patel, Nishant; Weiss, Eric S.; Alejo, Diane; Nwakanma, Lois U.; Williams, Jason A.; Dietz, Harry C.; Spevak, Philip J.; Gott, Vincent L.; Vricella, Luca A.; Cameron, Duke E.

doi:10.1016/j.athoracsur.2008.01.032

Cited by 131 publications

(84 citation statements)

References 27 publications

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“…В методике реимплантации корня аорты, как и при операции David, так же достигает-ся стабилизация фиброзного кольца аортального клапана. Стабилизация фиброзного кольца позволяет избежать возвратной аортальной регургитации в отдаленном пери-оде [6,8]. Укрепление стенки корня аорты позволяет пре-дотвратить дальнейшее расширение элементов корня аор-ты, в том числе и у пациентов с синдромом Марфана.…”

Section: Discussionunclassified

“…Выполняли реви-зию и визуальную оценку корня аорты и аортального кла-пана, после чего принимали решение о возможности со-хранения собственного клапана. Сохранение клапана осуществляли методом реимплантации корня аорты в протез [5,8,11], либо по методике David [12,13]. У 6 паци-ентов при операции Florida Sleeve использовали протез Maquet Cardioroot, у 14 пациентов -Vascutek Gelweave Valsalva.…”

Section: материал и методыunclassified

“…Ряд недостатков данной мето-дики -сложность и длительность, риск кровотечения, нарушение естественной биомеханики аортального кла-пана, риск травматизации створок, определенная непред-сказуемость -заставляют хирургов искать альтернативу [5][6][7]. Такой альтернативой стала предложенная в 2005 г. J. Philip Hess методика Florida sleeve [8], суть которой за-ключается в реимплантации всего корня аорты в дакроно-вый протез соответствующего размера, необходимого для достижения адекватной компетентности аортального кла-пана, с сохранением синусов Вальсальвы и без необходи-мости реимплантации устьев коронарных артерий.…”

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Short-term results of aortic root reimplantation surgery

Khwan¹,

Chernyavsky²,

Альсов³

et al. 2015

Kardiol. serdechno-sosud. khir.

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Section: Discussionunclassified

Section: материал и методыunclassified

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Short-term results of aortic root reimplantation surgery

Khwan¹,

Chernyavsky²,

Альсов³

et al. 2015

Kardiol. serdechno-sosud. khir.

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“…Although rates of thromboembolism and reoperation are higher after the Bentall procedure and after VSRR respectively, propensity score-adjusted Cox regression analysis revealed that the Bentall procedure neither predicts late mortality nor protects against a need for reoperation. 55) The largest and most recent study of 372 Marfan patients concluded that VSRR is promising, particularly when using reimplantation with a Valsalva graft, but it has not yet proven as durable as the Bentall procedure.…”

Section: Vsrr In Patients With Marfan Syndromementioning

confidence: 99%

Valve-sparing Aortic Root Replacement

Shimizu

Yozu

2011

ATCS

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The aortic root has a unique 3-dimensional configuration and the distinctive function of supporting the aortic valve and blood vessels. The sinuses of Valsalva are crucial to create appropriate eddy currents that are important in initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Most aneurysms in the aortic root are associated with degenerative changes in the elastic media rather than atherosclerosis. Valvesparing root repair has become widely accepted, although the Bentall procedure remains the gold standard. Because reimplantation using the Valsalva graft allows root geometry to be retained and theoretically and practically prevents recurrent aortic valve regurgitation, it is considered the most reliable and preferred technique among various valve-sparing aortic root repair procedures. Ann Thorac Cardiovasc Surg 2011; 17: 330-336 doi: 10.5761/atcs.ra.11.01675 Anatomy of the Aortic RootThe aortic root is the most proximal part of the aorta. It has a unique 3-dimensional (3D) configuration with a clover-like dilation of the sinuses of Valsalva within which the aortic valve forms a three-pronged crown. The attachment of each valve leaflet to the aortic wall is semilunar, running from the basal attachment within the left ventricle to the distal attachment at the sinotubular (ST) junction. The virtual circle connecting the lowest point on each semilunar attachment is called the basal ring. The posterior half of the basal ring (including the base of the non-coronary sinus) is fibrous, and the anterior half (including the base of the left and right coronary sinuses) is muscular. The fibrous portion is considered weaker and easy to dilate. The semilunar attachment forms a hemodynamic (but not an anatomical) junction between the left ventricle and the aorta. The anatomical ventriculo-aortic junction is the circle lying a little above the basal ring (Fig. 1).1) The bundle of His lies immediately below the membranous ventricular septum that lies immediately beneath the commissure between the right and noncoronary cusps (Fig. 2).2-4) The diameter of the aorta at the ST junction is 81% of the diameter at the aortic sinuses, and 97% at the basal ring. 5) Function of Aortic RootThe aortic root not only channels blood but also supports the aortic valve leaflets. The clover-like dilation of sinuses of Valsalva is crucial to create appropriate eddy currents in the supravalvular region, which are important for initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Etiology and Pathology of the Aortic RootMost aneurysms in the aortic root are associated with degenerative changes in the elastic media, although atherosclerosis is the major etiology of aneurysms in other regions of the aorta. This probably correlates with the higher concentration of elastic fibers in the media of the aortic root. Cystic medial degeneration, or elastic fiber fragmentation and smooth muscle loss, are typical of the histological characteristics of root aneurysms. Aortic root...

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“…Few series have compared valve repair with composite valve and graft replacement (Bassano et al, 2001;De Oliveira et al, 2003;Karck et al, 2004;Patel et al, 2008;Volguina et al, 2009;Zehr et al, 2004). Conclusions remain controversial since they were often retrospective, based on selected patients (Marfan), and compare different operating time periods, techniques and learning curve periods.…”

Section: Evaluation Of the Standardized Approach To Aortic Valve Repamentioning

confidence: 99%