Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center’s Experience

Liu, Shen; Shi, Yi; Liu, Ruofan; Tong, Minghui; Luo, Xiaoliang; Xu, Jie

doi:10.1016/j.athoracsur.2016.06.005

Cited by 12 publications

(8 citation statements)

References 39 publications

(45 reference statements)

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“…We appreciate Dr Yurekli and colleagues' [1] interest in and considerate comments on our published article [2]. As they pointed out, more patients with a preoperative diameter of ascending aorta larger than 5 cm were found in the bicuspid aortic valve (BAV) group than in the non-BAV group.…”

Section: Reply To the Editormentioning

confidence: 87%

Early Prognosis of Reduction Ascending Aortoplasty

Yurekli

Kestelli

Cakir

et al. 2019

The Annals of Thoracic Surgery

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Congratulations to Liu and colleagues [1] for this valuable effort. We want to point out some issues about their study. As a basic principle of physics it is obvious that turbulent blood flow will appear after aortic valve replacement because of the inflexible stent of the prosthetic valve (rigid structures do not change diameter). The pathogenesis of aortic aneurysm includes degeneration and rupture of the myofibrils of the vascular wall. According to Laplace's law, the larger the vessel radius is, the greater the required wall tension will be to withstand a given internal fluid pressure. Therefore, these patients are followed with measurements of their aortic diameters. In Table 1 of the paper by Liu and colleagues [1], the numbers of patients with ascending aorta diameters larger than 5 cm are significantly different between the groups with and without bicuspid aortic valves. This issue may create a standardization problem when performing anterior resection of the ascending aorta because myofibrils may be disrupted at the posterior wall, but the intact anterior aortic wall may be resected with anterior resection. Another problem with this study could be the absence of information on the size and brand names of the prosthetic valves. These factors may have an effect on follow-up of aortic dilation. If aortic diameter is a measurement, indexing with the patient's height or body surface area may give more accurate results.

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Section: Reply To the Editormentioning

confidence: 87%

Early Prognosis of Reduction Ascending Aortoplasty

Yurekli

Kestelli

Cakir

et al. 2019

The Annals of Thoracic Surgery

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“…Potential late complications include redilatation and aneurysm progression or dissection. Generally, reoperation and aortic dissection rates are reported extremely seldom ( 3 , 5 , 7 , 15 ). Our overall 98.8% freedom of RAA-related complications is comparable to other research ( 4 ) and our overall survival of 89.7% and freedom from aortic and cardiac-related death of 97.6% is excellent.…”

Section: Discussionmentioning

confidence: 99%

“…Current guidelines recommend ascending aneurysm replacement at aortic diameters of 55 mm in patients with tricuspid aortic valves (TAV), or 50 mm in patients with bicuspid aortic valves (BAV) in presence of risk factors or in patients with genetic connective tissue disorders (1,2). Although RAA is not recommended as the firstline procedure, it is suggested applicable in patients of higher age and unfit for extended aortic surgery (1), while connective tissue disorders are clear contraindications (3)(4)(5). High preoperative aortic diameters are assumed to promote redilatation (6,7) and in bicuspid aortic valves (BAV), aortic redilatation after RAA is suspected due to underlying histopathologic aortic wall changes (8).…”

Section: Introductionmentioning

confidence: 99%

Reduction ascending aortoplasty: A retrospective analysis of outcomes and risk factors

Szalkiewicz

Gökler²,

Dietl³

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesIndication for Reduction of Ascending Aortoplasty (RAA) and long-term outcomes remain unclear. This study analyzed the outcomes after nonreinforced RAA in two Austrian centers.MethodsPatients with RAA at two Austrian centers between 6/2,009 and 6/2,017 were retrospectively analyzed. Aortic diameters were measured by CT pre- and post-operatively. Patients were assigned according to valve morphology and imaging modality.ResultsOverall, 253 patients underwent RAA [women: 30.8%; median age 74 (63–79) years] with a mean preoperative ascending diameter of 44.7 (±3.5) mm. RAA-related postoperative adverse events occurred in 1.2% (n = 3) over a follow-up of a median of 3.8 (2.4–5.5) years: One type A aortic dissection, one lethal aortic rupture at the suture line, and one suture line bleeding with cardiac tamponade and need of surgical revision. The overall survival rate was 89.7%. Aortic valve morphology itself was no risk factor for mortality (Log-Rank: 0.942). One hundred and forty patients had a tricuspid [TAV: (55.3%)] aortic valve and 113 patients had a bicuspid aortic valve [BAV: (44.7%)]. Redilatation to a diameter >50 mm according to CT follow-up occurred in 5.7% (n = 5 of 87). One patient needed reoperation with RAA and aortic valve replacement due to a prosthesis-patient mismatch after aortic valve replacement and aortic redilatation.ConclusionNon-reinforced RAA is a safe, feasible, and reproducible procedure with low rates of perioperative complications in selected patients primarily undergoing aortic valve repair with a dilated ascending aorta. Aortic valve morphology has no impact on mortality after RAA.

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“…According to a recent study, postoperative monitoring of up to 15 years is required in order to see aortic affections following AVR and RAA or AVR only [ 39 ].…”

Section: ⧉ Discussionmentioning

confidence: 99%

Therapeutic approach comparison in bicuspid aortic valve aortopathy and clinical practice implications

Dima

Streian

Gaşpar³

et al. 2021

Rom J Morphol Embryol

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Bicuspid aortic valve (BAV) is the most common heart valve malformation, and it may be associated with the development of long-term complications, such as aortic stenosis (AS) secondary to valvular calcification and aortic insufficiency (AI), with or without ascending aortic aneurysm (AAA). This study was performed at the Institute of Cardiovascular Diseases, Timişoara, Romania, from 2015 through 2018 and included a total of 105 patients with BAV. Out of the 105 BAV patients, 14 displayed AAA, alongside either AS or AI, and were selected undergo aortic valve replacement (AVR) alongside surgical replacement or aortoplasty of the ascending aorta, and the elastic fiber loss in the ascending aortic wall was evaluated for each patient. Two surgical interventions used alongside AVR in BAV patients with AAA and AS or AI were compared in this study: reduction ascending aortoplasty (RAA) and ascending aorta replacement (AAR). Postoperative follow-ups have shown RAA is useful short-term but that, in contrast to AAR, it leads to aortic redilatation over time. These results can contribute to a major future meta-analysis with the goal of improving the current clinical practice guidelines for BAV aortopathy.

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Early Prognosis of Reduction Ascending Aortoplasty in Patients With Aortic Valve Disease: A Single Center’s Experience

Abstract: Reduction ascending aortoplasty shows good early results in patients with aortic valve disease and dilatation of the ascending aorta. Redilatation tends to happen in patients with BAV, and long-term follow-up is necessary.

Cited by 12 publications

References 39 publications

Early Prognosis of Reduction Ascending Aortoplasty

Early Prognosis of Reduction Ascending Aortoplasty

Reduction ascending aortoplasty: A retrospective analysis of outcomes and risk factors

Therapeutic approach comparison in bicuspid aortic valve aortopathy and clinical practice implications

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