Aortic Root Replacement for Ascending Aortic Disease: A 10 Year Review

Complex aortic surgery in a regional center in the United Kingdom. Should the United Kingdom now adopt a United States–style supercenter model?

“…Outside the United Kingdom, in-hospital mortality from elective surgery on the thoracic aorta ranges from 5% to 10% in regional centers. 18,19 High-volume (super) centers had lower hospital mortality (as low as 3.7% in some centers) in addition to lower postoperative morbidity for thoracic aneurysm repairs compared with low-volume centers not only in the United States but across the world. 20,21 Long-term mortality in other UK regional centers, international regional centers, and supercenters.…”

Surgery for mitral regurgitation in patients with aortic root aneurysm: Transaortic or transseptal approach?

“…At the same time, a rather part of patients with aortic root aneurysm suffered from MV regurgitation [1][2][3], which might be related to the dilation of left ventricle and the degeneration of mitral valvular tissues [11,12]. MV regurgitation can lead to serious complications, including atrial fibrillation, stroke, dilation of left ventricular, chronic heart failure, and even the acute onset of heart failure [13][14][15].…”

“…Many patients with aortic root aneurysm simultaneously developed mitral valve (MV) regurgitation [1,2]. According to 10-year experience from a single center, there were 5.6% (4 to 52) in patients who suffered from aortic root aneurysm, also underwent MV surgery at the same time [3]. Owing to the anatomic relationship between the aortic and mitral valves, and the potential reoperation of MV after aortic root replacement, it was extremely vital to address MV regurgitation in patients with aortic root aneurysm combined with mitral valve regurgitation [1,4].…”

“…Owing to the anatomic relationship between the aortic and mitral valves, and the potential reoperation of MV after aortic root replacement, it was extremely vital to address MV regurgitation in patients with aortic root aneurysm combined with mitral valve regurgitation [1,4]. Both mitral valve plasty (MVP) and mitral valve replacement (MVR) could be performed in these patients to treat the MV regurgitation [1,3,5], via a transverse aortotomy or a transatrial septum [6][7][8]. Although a rather part of patients with aortic root aneurysm were also combined with mitral valve regurgitation from our single center experience from March 2010 to April 2015, this pathology was rarely discussed in previous literatures and surgeons had little data to help guide their decisions of the optimal surgical strategy of MV regurgitation in patients with aortic root aneurysm undergoing aortic replacement.…”

The David Operation Offers Shorter Hemostasis Time Than the Bentall in Case of Acute Aortic Dissection Type A

“…Some patients with acute aortic dissection type A (AADA) require aortic root replacement (ARR) because of the enlarged aortic root, extensive tissue destruction of the aortic root, and/or intimal tears located in the aortic root. In such patients, the Bentall operation using a composite graft with a vascular prosthesis and an artificial valve used to be the gold standard [1][2][3], but in recent years, valve-sparing ARR (VSRR) has been gaining attention, especially for young patients [4][5][6][7]. However, VSRR is a more complex and timeconsuming procedure than the Bentall operation, and, therefore VSRR, has not been widely adopted in patients with AADA despite its potential benefits.…”