Aortic root replacement with coronary button re-implantation: low risk and predictable outcome

Westaby, Stephen; Katsumata, Takahiro; Vaccari, Giuseppe

doi:10.1016/s1010-7940(00)00347-x

Cited by 43 publications

(37 citation statements)

References 18 publications

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“…4,6,7,9,10) In a report by Midulla and colleagues, acute type A dissection, rupture, new preoperative neurological symptoms, and the Cabrol technique were associated with a higher hospital mortality in univariate analysis, but by multivariate analysis no independent risk factors wrer demonstrated, as in our study.…”

Section: Discussionsupporting

confidence: 57%

“…Our mortality and mid-term survival rates compare favorably with those reported by others. 2,3,10) Modified Bentall procedures are safe in general. Meticulous dissection as well as careful handling and positioning of the coronary buttons are of paramount importance in patients with a stiff aortic root since technical errors are more likely to occur.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Perioperative Risk Factors in Mortality and Morbidity after Modified Bentall Operation.

et al. 2002

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SUMMARYThe objective of the present study was to determine the risk factors for operative and short-term mortality, and morbidity after a Bentall operation. Between July 1994 and February 2001, 86 consecutive patients (70 males) underwent a modified Bentall operation at our hospital. The aortic pathology was acute aortic dissection in 12 (14%), chronic dissection in 9 (10.5%) and degenerative aneurysm in 65 (75.6%). Mean age was 48±15 years. Eleven preoperative, 8 intraoperative and 6 postoperative variables of these patients were retrospectively analyzed using univariate and multivariate logistic regression analysis. Six patients died in the hospital (6.9%) and 2 died within four months after being discharged from the hospital. Mean follow-up time was 33±23 months (2 months to 8 years). The survival rate among hospital survivors was 88% at 3 years and 77% at 6 years. Univariate predictors of in-hospital and short-term mortality were the presence of aortic valve calcification, stenotic aortic valves, renal failure, and cardiac failure after the operation. Multivariate analysis revealed no independent risk factors. Risk factors for morbidity were etiology of acute dissection, use of circulatory arrest, transfusion of blood and fresh frozen plasma more than 2 units each, cross clamp and cardiopulmonary bypass times (exceeding 90 and 140 minutes, respectively), and performing concomitant procedures.Modified Bentall procedures are safe in general. Meticulous dissection, careful handling and positioning of the coronary buttons are of paramount importance in patients with stiff aortic root since technical errors are more likely to occur. (Jpn Heart J 2002; 43: 151-157)

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Analysis of Perioperative Risk Factors in Mortality and Morbidity after Modified Bentall Operation.

et al. 2002

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“…The advent of direct coronary button reimplantation has enhanced safety and durability of the procedure [2,3]. The overall mortality associated with ARR is now in the range of 2% -6% in recent studies [3][4][5][6][7][8][9]. In series presented in this clinical report, this procedure was very safe, with an overall mortality of only 2.95%.…”

Section: Discussionmentioning

confidence: 86%

“…However, aortic root replacement procedures still carry some peri-operative risk, with experienced centers noting contemporary operation-related mortality of 2% to 6% [3][4][5][6][7][8][9]. In a previous paper, we highlighted the potential problems related to attachment of the coronary artery buttons that can produce acute ischemia in the operating room or shortly thereafter, thus jeopardizing immediate survival [8].…”

Section: Introductionmentioning

confidence: 99%

Late Anatomic Findings after “Rescue CABG” for Peri-Operative Ischemia Following Aortic Root Replacement

Ramarathnam¹,

Javier²,

Farkas³

et al. 2013

WJCS

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Background: Acute myocardial ischemia, seen in about 2% of aortic root replacements (ARR), is acutely life-threatening, manifesting as failure to wean from bypass, ventricular fibrillation, or unstable hemodynamics. The exact precipitating anatomic cause is usually not apparent at the time of surgery. In this report, we take advantage of late computed tomographic (CT) angiograms of long-term survivors of peri-operative ischemia after ARR to determine what abnormalities of the coronary button reattachments produced the peri-operative ischemia. Methods: The database of the Aortic Institute at Yale-New Haven was reviewed to identify all patients undergoing ARR over a 15-year period. Operative records, patient charts, and CT angiograms of patients who had peri-operative ischemia were reviewed in detail, including analysis by an imaging specialist. Results: 271 patients underwent ARR, 220 with mechanical and 51 with biological valved conduits. Hospital mortality was 2.95%. Clinical follow-up ranged from 1 to 182 months. Survival in discharged patients was 97.7% at 5 years and 95.2% at 7 years. Peri-operative ischemia was seen in 4 of 271 patients (1.5%). All four affected patients survived-with interventions including supplemental coronary bypass grafts (4 patients), intra-aortic balloon pump placement (2 patients), and left ventricular assist device insertion (1 patient). Late CT angiograms revealed severe but non-obstructive left main calcification serving as a focal point for coronary angulation in 2 patients, angulation without calcification in 1 patient, and totally normal anatomy in 1 patient. Conclusions: Myocardial ischemia after ARR is rare but acutely life-threatening. Prompt recognition and treatment by supplemental coronary artery bypass grafting preserves life and leads to good late survival. Intramural calcification (non-obstructive) of the distal left main coronary artery predisposes to angulation after coronary button creation and should be a "red flag" for this potential problem.

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“…Aortic root replacement (ARR) is a well-described and highly effective technique for treating aortic root pathologies with excellent long-term outcomes and reported mortality ranging between 4-10% in specialized aortic centers [1][2][3]. Coronary button reimplantation is arguably one of the most challenging aspects of ARR operations, requiring mobilization and reattachment of the coronaries to the root graft.…”

Section: Introductionmentioning

confidence: 99%

Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

Calcaterra¹,

Jazayeri²,

Parekh³

et al. 2017

aorta

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Background: Coronary button reimplantation can represent a technical challenge of aortic root reconstruction that can be associated with significant morbidity and mortality. With the goal of simplifying coronary reimplantation and reducing the incidence of related complications, we designed a new Dacron graft with prefabricated coronary branches to minimize coronary artery mobilization and prevent the potential mechanical complications of reattachment to the body of the graft. Methods: Between June 2010 and May 2012, we implanted the graft in eight patients (six males, two females) ranging in age from 42-68 years (mean, 54 years). Six procedures were modified Bentall reconstructions, and two procedures were valvesparing root replacements using the reimplantation technique. Results: There were no complications and no morbidity or mortality related to coronary reattachment. All patients were alive and doing well at a mean follow-up of 26 months (range, 17-38 months). At an extended mean follow-up of 42 months (range, 25-56 months), one patient died of stroke-related complications. No radiologic or clinical evidence of impairment of coronary perfusion was identified in any patient. Conclusions: The use of this new graft model may simplify the technique of root reconstruction and potentially lower the incidence of mechanical complications related to coronary button reimplantation.

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Aortic root replacement with coronary button re-implantation: low risk and predictable outcome

Abstract: Button reimplantation with the sequence described is predictable and safe. Wrap-around is unnecessary. Coronary aneurysms have been eliminated.

Cited by 43 publications

References 18 publications

Analysis of Perioperative Risk Factors in Mortality and Morbidity after Modified Bentall Operation.

Analysis of Perioperative Risk Factors in Mortality and Morbidity after Modified Bentall Operation.

Late Anatomic Findings after “Rescue CABG” for Peri-Operative Ischemia Following Aortic Root Replacement

Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

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