Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure

Pethig, Klaus; Milz, Andrea; Hagl, Christian; Harringer, Wolfgang; Haverich, Axel

doi:10.1016/s0003-4975(01)03312-4

Cited by 109 publications

(75 citation statements)

References 23 publications

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“…The different methods used are based on an estimation of the STJ to give an optimal cusp coaptation, 1,2,11 on the VAJ diameter, 9 or on the height of the cusps. 2,15 In our opinion, whatever the sizing method used, downsizing of the graft is probably worse than oversizing, especially in patients with large cusps. Effectively, downsizing results in an abnormal valve configuration with cusp billowing in the outflow tract and low coaptation.…”

Section: De Kerchove Et Al Aortic Insufficiency and Sparing Surgery S123mentioning

confidence: 79%

Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve–Sparing Surgery

et al. 2009

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Background-The presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been suggested as a risk factor for poorer outcomes after aortic valve (AV)-sparing surgery. We analyzed the influence of these factors on the mid-term outcomes of AV surgery. Methods and Results-Between 1996 and 2008, 164 consecutive patients underwent elective AV-sparing surgery. Severe preoperative AI (grade Ն3ϩ) was present in 93 patients (57%), and 54 (33%) had a bicuspid valve. Root repair was performed with either the reimplantation (74%) or the remodeling (26%) technique, and cusp repair was performed in 90 patients (55%). Mean clinical follow-up was 57 months. Hospital mortality was 0.6%. Cusp repair was required in 52% of the patients with preoperative AI Յ2ϩ and in 57% of those with AI Ն3ϩ (Pϭ0.6). Cusp repair was required more frequently in bicuspid versus tricuspid valves (91% versus 38%, PϽ0.001). Overall survival at 8 years was 88Ϯ8%. Freedom from AV reoperation at 8 years was similar with preoperative AI Յ2ϩ versus preoperative AI Ն3ϩ (89Ϯ11% versus 90Ϯ7%, Pϭ0.7) and with versus without cusp repair (84Ϯ17% versus 92Ϯ8%, Pϭ0.5). Freedom from recurrent AI (grade Ն3ϩ) at 5 years was also similar between groups (90Ϯ10% versus 89Ϯ8%, Pϭ0.9, and 90Ϯ8% versus 89Ϯ9%, Pϭ0.8, respectively). By multivariate analyses, predictors of recurrent AI Ն2ϩ were preoperative left ventricle end-diastolic diameter and AI Ͼ1ϩ on discharge echocardiography. Conclusions-With a systematic approach to cusp assessment and repair, AV-sparing surgery for root pathology has an acceptable mid-term outcome, irrespective of preoperative AI or need for cusp repair. (Circulation. 2009;120[suppl 1]: S120-S126.)

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Section: De Kerchove Et Al Aortic Insufficiency and Sparing Surgery S123mentioning

confidence: 79%

Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve–Sparing Surgery

et al. 2009

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“…In our experience, aortic annulus diameter was 21 Statistical analysis showed no significant differences in terms of body surface area between the healthy population and the study population. For the David operation high predictive value of our normogram was confirmed by the absence of any significant statistical difference between predicted and observed beyond leaflets area (Table 2).…”

Section: Resultsmentioning

confidence: 71%

“…Pethig [21] demonstrated that morphology of final aortic leaflets coaptation and grading of eventual residual aortic regurgitation has a strong impact on long-term durability of the repair. The competence of the aortic valve is therefore the key to a good result.…”

Section: Discussionmentioning

confidence: 99%

A normogram to anticipate dimension of neo-sinuses of valsalva in valve-sparing aortic operations☆

Maselli

Montalto

Santise

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Objective: The aim of the present study was to define a method to pre-determine the correct size of neo-sinuses of Valsalva in the reimplantation type of valve-sparing aortic operation. Methods: The objective was achieved in three steps: (1) evaluation in the healthy population, of the normal size of sinuses of Valsalva expressed as the area surrounding fully opened aortic cusps, the so-called beyond leaflets area; (2) elaboration of a normogram by which, given a known annular diameter, it is possible to select the appropriate graft size to obtain a normal beyond leaflets area; (3) validation of the normogram by comparing, in a population of 20 patients undergoing a valve-sparing procedure, the predicted and observed beyond leaflets area. Results: The following values for beyond leaflets area were observed: mean normal 320.6G 120.6 mm 2 , mean predicted 355G63.2 mm 2 , mean observed 364.7G72.8 mm 2 .No significant differences were obtained for predicted versus observed values. Regression analysis showed a linear distribution with an r value of 0.95. Conclusions: We proposed a simplified approach for sizing of the neo-aortic root in the reimplantation type of valve-sparing aortic operation focussed on the size of sinuses of Valsalva. Our normogram showed to be reliable in anticipating beyond leaflets area. It can be helpful in avoiding the selection of an undersized or excessively oversized graft. Q

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“…AR in the presence of normal leaflets is mainly due to aortic root dilatation, but when this is corrected, the root dimensions and the relationships between its components are changed, so it is common to produce a leaflets prolapse after valve-preserving surgery (21,22). It will be necessary to apply some technique on them to recover an adequate morphology with good effective height and coaptation surface.…”

Section: Techniques On the Leafletsmentioning

confidence: 99%

Sparing aortic valve techniques

Álvarez-Cabo

2017

J. Thorac. Dis.

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Prosthetic valve implantation is the most widely used therapeutic option for aortic regurgitation (AR), but complications associated with prosthetic valves, with an incidence of 3-5% patient/year, and the need for anticoagulation in mechanical valves, force us to consider aortic valve repair as an alternative to the prosthetic implant, especially in young people with many potential years of life for these complications.Aortic valve repair techniques are not excessively complicated, but there is no standardization, so they are not reproducible in all medical centers. There are multiple repair procedures, but to study them we can divide, arbitrarily, into two large groups, techniques for treatment of aortic root dilatation (reimplantation and remodeling); and repair techniques without treatment of the aortic root, that act on annulus and on aortic leaflets. The two sets of techniques are often used together, but it is easier to understand them if this arbitrary division is made. Our goal is to publish our experience and knowledge of repair techniques to facilitate their learning by other professionals. In this article, we will focus on the procedures on the aortic annulus and leaflets, because they can be applied in patients without aortic root dilatation, but they are also complementary to the reimplantation and remodeling techniques. We will present the procedures describing them individually, with an explanation in text accompanied by three videos in which the application of each technique is visualized in several cases. The standardization of sparing aortic valve techniques is difficult, because each patient requires its individualized application, yet we have tried to illustrate reproducible procedures so that professionals have more tools to deal with aortic valve-preserving surgery.

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Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure

Cited by 109 publications

References 23 publications

Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve–Sparing Surgery

Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve–Sparing Surgery

A normogram to anticipate dimension of neo-sinuses of valsalva in valve-sparing aortic operations☆

Sparing aortic valve techniques

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