Early and Medium Term Results of the Sleeve Valve-Sparing Procedure for Aortic Root Ectasia

Gamba, Amando; Tasca, Giordano; Giannico, Floriana; Lobiati, Elisabetta; Skouse, D; Galanti, Andrea; Martino, Antonello Stefano; Triggiani, Michele

doi:10.1016/j.athoracsur.2014.10.044

Cited by 20 publications

(19 citation statements)

References 13 publications

(24 reference statements)

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“…In this specific technique, the whole AR is preserved and sheathed by a Valsalvashaped graft, which has to be properly sized depending on the dimensions of the native anatomy. 40 Second, accounting for prestresses led to changes in the stresses acting on the aortic wall as compared with the values computed when neglecting prestresses. Such changes were not massive over a large fraction of the aortic wall.…”

Section: Effect Of Prestresses On Numerical Resultsmentioning

confidence: 98%

“…Another relevant application could be the analysis of the Sleeve technique, ie, a recent AV sparing technique for the treatment of AR aneurysm. In this specific technique, the whole AR is preserved and sheathed by a Valsalva‐shaped graft, which has to be properly sized depending on the dimensions of the native anatomy . Second, accounting for prestresses led to changes in the stresses acting on the aortic wall as compared with the values computed when neglecting prestresses.…”

Section: Discussionmentioning

confidence: 99%

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A novel approach to the quantification of aortic root in vivo structural mechanics

Votta

Presicce

Corte

et al. 2016

Numer Methods Biomed Eng

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Understanding aortic root in vivo biomechanics can help in elucidating key mechanisms involved in aortic root pathologies and in the outcome of their surgical treatment. Numerical models can provide useful quantitative information. For this to be reliable, detailed aortic root anatomy should be captured. Also, since the aortic root is never unloaded throughout the cardiac cycle, the modeled geometry should be consistent with the in vivo loads acting on it. Achieving such consistency is still a challenge, which was tackled only by few numerical studies. Here we propose and describe in detail a new approach to the finite element modeling of aortic root in vivo structural mechanics. Our approach exploits the anatomical information yielded by magnetic resonance imaging by reconstructing the 3-dimensional end-diastolic geometry of the aortic root and makes the reconstructed geometry consistent with end-diastolic loading conditions through the estimation of the corresponding prestresses field. We implemented our approach through a semiautomated modeling pipeline, and we applied it to quantify aortic root biomechanics in 4 healthy participants. Computed results highlighted that including prestresses into the model allowed for pressurizing the aortic root to the end-diastolic pressure while matching the image-based ground truth data. Aortic root dynamics, tissues strains, and stresses computed at relevant time points through the cardiac cycle were consistent with a broad set of data from previous computational and in vivo studies, strongly suggesting the potential of the method. Also, results highlighted the major role played by the anatomy in driving aortic root biomechanics.

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Section: Effect Of Prestresses On Numerical Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

A novel approach to the quantification of aortic root in vivo structural mechanics

Votta

Presicce

Corte

et al. 2016

Numer Methods Biomed Eng

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“…Gamba et al 11 found no severe AI and only 1% moderate AI after 18 ± 9 months of the sleeve procedure. On the other hand, Hess et al's FL Sleeve report has described improvement of AI at 1 week following the FL Sleeve procedure, but a trend toward increasing mean AI grades at 2 years, which raised doubt on the durable improvement of aortic valve function with the FL Sleeve procedure.…”

Section: Discussionmentioning

confidence: 94%

“…8 9 Moreover, the most recent study comparing biomechanical characteristics of the FL Sleeve and previous AVS techniques found that the FL Sleeve technique is even superior to previous AVS techniques in biomechanical standpoint as it leads to lower aortic valve stress and prevents possible aortic root distortion or harmful aortic wall stresses. 10 Hess et al 8 9 and Gamba et al 11 have reported encouraging early and midterm outcomes of the FL Sleeve procedure. In contrast to large studies incorporating David and Yacoub techniques, 5 7 12 all prior reports about the FL Sleeve procedure have included limited numbers of patients and reported early or midterm outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Aalaei‐Andabili

Martin

Hess

et al. 2019

Aorta

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Background The Florida (FL) Sleeve procedure was introduced as a simplified approach for valve-sparing correction of functional Type I aortic insufficiency (AI) associated with aortic root aneurysms. In this study, short- and long-term outcomes after the FL Sleeve procedure were investigated. Methods From May 2002 to January 2016, 177 patients underwent the FL Sleeve procedure. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter, left ventricular ejection fraction, and degree of AI (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4) were evaluated by echocardiography. Results Mean ± standard deviation of age was 49.41 ± 15.37 years. Survival rate was 98% at 1 year, 97% at 5 years, and 93% at 8 years. Freedom from reoperation was 99% at 1 year and 98% at 2 to 8 years. Three patients (1.69%) died during hospitalization. Three patients (1.69%) developed periprocedural stroke. Postoperative follow-up echocardiography was available in 140 patients at 30 days, and 31 patients at 5 years. AI grade significantly improved from baseline at 30 days (2.18 ± 1.26 vs. 1.1 ± 0.93, p < 0.001) and at 5 years (2.0 ± 1.23 vs. 1.45 ± 0.88, p = 0.04). Preoperative mean LVEDD significantly decreased from 52.20 ± 6.73 to 46.87 ± 8.40 (p < 0.001) at 30 days, and from 53.22 ± 7.07 to 46.61 ± 10.51 (p = 0.01) at 5 years. Conclusions The FL Sleeve procedure is a safe, effective, and durable treatment of aortic root aneurysm and Type I AI. Long-term survival and freedom from reoperation rates are encouraging.

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“…The Florida sleeve operation has been proposed as an alternative method to repair the aortic root and to spare the aortic valve, in the setting of annuloaortic ectasia. Gamba et al 6 demonstrated satisfactory long-term outcome after application of the Florida sleeve technique with a mean clinical follow-up of 34 ± 19 months. The Florida sleeve occasionally has been proposed as a method to treat acute Type A aortic dissection to avoid bleeding and aortic valve replacement.…”

Section: Discussionmentioning

confidence: 98%

Unusual, Radical Treatment of Type A Aortic Dissection: A Case Report

et al. 2020

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Type A aortic dissection, according to Stanford classification, is a surgical emergency with high morbidity and carries 56% of in-hospital mortality when surgical intervention is not performed. The surgical mortality at 30 days is 10 to 20%. The therapeutic goals are to replace the diseased ascending aorta and to treat or to monitor the distal aortic patent false lumen. When the dissection involves the aortic root and the architecture of aortic valve is normal, the surgical techniques used could be multiple: reinforce the aortic root and spare the native aortic valve or replace the aortic valve and the aortic root. The Florida sleeve technique has been developed to treat the aortic aneurysm, sparing the aortic valve in patients with connective tissue disease. Some case reports have described the use of this technique to treat an acute aortic dissection. In the following case, we present a single stage repair of the ascending aorta, aortic arch, and proximal intrathoracic aorta in a patient with Type A aortic dissection through the contemporaneous use of two techniques: Florida sleeve and Vascutek “Thoraflex” hybrid prosthesis. The use of these two techniques allows the repair/replacement of the proximal intrathoracic aorta, the sparing of the native aortic valve, the employment of a hybrid prosthesis to replace the supraortic vessels, and the creation of a descending aortic landing zone for later, distal intervention.

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Early and Medium Term Results of the Sleeve Valve-Sparing Procedure for Aortic Root Ectasia

Cited by 20 publications

References 13 publications

A novel approach to the quantification of aortic root in vivo structural mechanics

A novel approach to the quantification of aortic root in vivo structural mechanics

The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Unusual, Radical Treatment of Type A Aortic Dissection: A Case Report

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