At the Root of the Repair Debate: Outcomes After Elective Aortic Root Replacements for Aortic Insufficiency With Aneurysm

Aim: The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). Methods: A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.

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“…7 Long-term outcomes are similar with mechanical- versus biological-valved conduit aortic root replacements, even in patients <70 years old. 8…”

Section: Aneurysmsmentioning

confidence: 99%

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Isselbacher¹,

Preventza²,

Black³

et al. 2022

Circulation

639

410

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“…Bilkhu and associates reported 1.2% in-hospital mortality in a cohort of 344 patients who underwent root replacement in a large-volume institution [Bilkhu 2016]. Similarly, McCarthy and colleagues described their experience with elective root replacement for aneurysm in a group of 220 patients, and they reported 2% 30-day mortality for patients with severe aortic insufficiency (AI), and 0% mortality for patients with moderate (or less) AI [McCarthy 2016].…”

Section: Discussionmentioning

confidence: 99%

Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes

Hemli

DeLaney

Dholakia

et al. 2017

HSF

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“…Their series was later updated and demonstrated freedom from reoperation of 89.6%±2.9% at ten years, while the percentage of patients with AI grade 1+ increased from 40% to 51%, 2+ from 5% to 11%, 3+ from 0% to 2% and 4+ from 0% to 1% at ten years ( 24 ). McCarthy et al found that long-term survival was impaired in those with preoperative severe AI (HR =2.6, P=0.04) ( 25 ). Deas et al compared eccentric AI jets to concentric jets and found no statistical difference in the cumulative risk of aortic valve replacement at ten years but the absolute numbers, 0% vs. 9.4%, may indicate further study in this area ( 26 ).…”

Section: Vsrr With Severe Aimentioning

confidence: 99%

Aortic valve-sparing root replacement or Bentall?

Iannacone¹,

Lau²,

Soletti³

et al. 2023

Ann Cardiothorac Surg

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Surgery of the aortic root is a challenging operation for which different techniques have been developed and refined over the last five decades. We present a review of surgical strategies and their most relevant modifications along with a summary of the most recent evidence on early and long-term outcomes. Additionally, we provide brief descriptions of the use of the valve-sparing technique in various clinical settings, including high-risk patients such as those with connective tissue disorders or concomitant dissection.

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At the Root of the Repair Debate: Outcomes After Elective Aortic Root Replacements for Aortic Insufficiency With Aneurysm

Cited by 9 publications

References 30 publications

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes

Aortic valve-sparing root replacement or Bentall?

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