Incidence, Cause, and Outcome of Reinterventions After Aortic Root Replacement

Yamabe, Tsuyoshi; Pearsall, Christian; Zhao, Yanling; Kurlansky, Paul; Bethancourt, Casidhe-Nicole; Nitta, S; George, Isaac; Smith, Craig R.; Takayama, Hiroo

doi:10.1016/j.athoracsur.2021.03.004

Cited by 11 publications

(5 citation statements)

References 20 publications

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“…On the contrary, an exception was made for the development of proximal abscess pseudoaneurysms due to prosthetic endocarditis observed in 10 patients during follow-up. Yamabe et al [16], on a series of 580 patients undergoing modified Bentall operation, reported that at 10 years there was a 6.1% reoperation rate for noninfectious causes. Of the 34 reoperated patients, cause of reoperation was, in 20.6% of cases, the formation of pseudoaneurysms or aneurysms of the aorta distal to the prosthetic conduit, and, in 2.9% of cases, the development of coronary button pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, from our analysis, we do not believe that the extensive use of biological prostheses for younger patients is justified, as the operative risk of reoperation may exceed that associated with long-term anticoagulant therapy. Moreover, the reported risk of redo operation is higher than 7%, and if the etiology is endocarditic, it reaches over 20% [16,19,20]. One reason for the low incidence of thromboembolic and hemorrhagic valve mechanical-related events may be found in the particular care that physicians and younger patients take in taking anticoagulant therapy at the correct dosage, to maintain the INR range between two and three.…”

Section: Discussionmentioning

confidence: 99%

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Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

Nardi

Pisano

Bassano

et al. 2022

IJERPH

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Aim: To analyze early and mid-term outcomes of the Bentall operation. Methods: Two hundred and seventeen patients (mean age 65.6 ± 15.9 years, males/females 172/45) underwent Bentall operation in a 7-year period (January 2015–December 2021), on average, 30 Bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta–aortic root aneurysms. Associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). Mean follow-up was 55.2 ± 24 (median 60.2) months. Cox model analysis was used to assess risk factors, Kaplan–Meier and log-rank tests were used to assess different survival rates. Results: Operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% ± 2%, 99% ± 1%, and 81% ± 5%. NYHA class (p < 0.0001), trans-aortic valve mean (p < 0.0001) and maximum (p < 0.000) gradients, left ventricular hypertrophy (p < 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. Concomitant CABG during Bentall operation independently affected late outcomes (HR 1.9–2.3; p-values < 0.05). Late survival was affected by concomitant CABG (84% ± 8% vs. 95% ± 2%, p = 0.04), preoperative myocardial infarction (91% ± 9% vs. 97% ± 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% ± 9% vs. 95% ± 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% ± 14% vs. 85% ± 5%, p = 0.005) and biological prostheses (78% ± 8% vs. 84% ± 6%, p = 0.06). Freedom from endocarditis–redo operation was 83% ± 9% for biological prostheses vs. 89% ± 6% for mechanical prostheses (p = 0.49). Conclusions: Low rates of operative mortality and late complications make Bentall operation the gold standard for the treatment of ascending aorta–aortic root aneurysms. Coronary ischemic disease affects late outcomes. Biological prostheses should be preferred for the elderly.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

Nardi

Pisano

Bassano

et al. 2022

IJERPH

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“…VSRR has been widely recognized as the optimal choice of the procedure for the aortic root pathologies due to its durability and long term survival. 1 Yamabe and colleagues 2 reported 7 cases (0.8%) of aorta-related reintervention in a series of 882 cases of aortic root replacement, including Bentall procedure, most of which were associated with distal anastomosis pseudoaneurysm. Only a few case reports have been published previously about LVOT pseudoaneurysm accompanied by tearing of the subannular suture and direct or patch closure/total root replacement.…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic pseudoaneurysm 8 years after valve-sparing aortic root replacement

et al. 2022

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“…Aortic root replacement (ARR) is an established surgical approach for a large range of aortic root pathologies such as aortic aneurysms, dissections, and infective endocarditis 1 with highly favorable early and late outcomes. 2,3 Mechanical valves are now less frequently employed compared to approaches involving aortic valve repair like valve-sparing ARR (VSARR, i.e., Tirone-David and Yacoub interventions), 4,5 or combined bioprosthetic aortic valve replacement (AVR) with ARR with either a stented or stentless valve (Bentall). 6,7 Nevertheless, some patients may ultimately require surgical reintervention for aortic structural valve deterioration (SVD).…”

Section: Introductionmentioning

confidence: 99%

Transcatheter valve‐in‐valve interventions after aortic root replacement: A systematic review

Baudo,

Cuko,

Ternacle

et al. 2024

Cathet Cardio Intervent

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Structural valve deterioration after aortic root replacement (ARR) surgery may be treated by transcatheter valve‐in‐valve (ViV‐TAVI) intervention. However, several technical challenges and outcomes are not well described. The aim of the present review was to analyze the outcomes of ViV‐TAVI in deteriorated ARR. This review included studies reporting any form of transcatheter valvular intervention in patients with a previous ARR. All forms of ARR were considered, as long as the entire root was replaced. Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases were searched until September 2023. Overall, 86 patients were included from 31 articles that met our inclusion criteria out of 741 potentially eligible studies. In the entire population, the mean time from ARR to reintervention was 11.0 years (range: 0.33–22). The most frequently performed techniques/grafts for ARR was homograft (67.4%) and the main indication for intervention was aortic regurgitation (69.7%). Twenty‐three articles reported no postoperative complications. Six (7.0%) patients required permanent pacemaker implantation (PPI) after the ViV‐TAVI procedure, and 4 (4.7%) patients had a second ViV‐TAVI implant. There were three device migrations (3.5%) and 1 stroke (1.2%). Patients with previous ARR present a high surgical risk. ViV‐TAVI can be considered in selected patients, despite unique technical challenges that need to be carefully addressed according to the characteristics of the previous surgery and on computed tomography analysis.

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Incidence, Cause, and Outcome of Reinterventions After Aortic Root Replacement

Cited by 11 publications

References 20 publications

Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

Asymptomatic pseudoaneurysm 8 years after valve-sparing aortic root replacement

Transcatheter valve‐in‐valve interventions after aortic root replacement: A systematic review

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