Midterm follow-up of the reimplantation technique in patients with relatively normal annulus: Is David I still a clinically valid option?

Mignosa, Carmelo; Stefano, Salvatore Di; Mazzamuto, Massimo; Degno, Nello; Mariani, Carlo; Romeo, Alessia; Rubino, Antonio

doi:10.1016/j.jtcvs.2013.11.042

Cited by 4 publications

(2 citation statements)

References 36 publications

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“…Studies using cylindrical grafts (with or without modification) report 5-year freedom from reoperation between 91% and 98% and those reporting exclusive use of the David I technique (SG without modification) report 91%-97% freedom from reoperation at 5 years. [20][21][22][23][24] Making comparisons between this assortment of studies with varying conditions is nearly impossible, so we sought to compare these 2 grafts in a controlled ex vivo environment to elucidate the mechanisms behind this disparity.…”

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confidence: 99%

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

Paulsen

Kasinpila

Imbrie-Moore

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: The optimal conduit for valve-sparing aortic root replacement is still debated, with several conduit variations available, ranging from straight tubular grafts to Valsalva grafts. Benefits of neosinus reconstruction include enhanced flow profiles and improved hemodynamics. Curiously, however, some clinical data suggest that straight grafts may have greater long-term durability. In this study, we hypothesized that straight tubular grafts may help maintain the native cylindrical position of the aortic valve commissures radially, resulting in preserved leaflet coaptation, reduced stresses, and potentially improved valve performance.Methods: Using 3D printing, a left heart simulator with a valve-sparing root replacement model and a physiologic coronary circulation was constructed. Aortic valves were dissected from fresh porcine hearts and reimplanted into either straight tubular grafts (n ¼ 6) or Valsalva grafts (n ¼ 6). Conduits were mounted into the heart simulator and hemodynamic, echocardiographic, and high-speed videometric data were collected.Results: Hemodynamic parameters and coronary blood flow were similar between straight and Valsalva grafts, although the former were associated with lower regurgitant fractions, less peak intercommissural radial separation, preserved leaflet coaptation, decreased leaflet velocities, and lower relative leaflet forces compared with Valsalva grafts.Conclusions: Valsalva grafts and straight grafts perform equally well in terms of gross hemodyanics and coronary blood flow. Interestingly, however, the biomechanics of these 2 conduits differ considerably, with straight grafts providing increased radial commissural stability and leaflet coaptation. Further investigation into how these parameters influence clinical outcomes is warranted. (J Thorac Cardiovasc Surg 2019;158:392-403) Variation (yellow arrows) between Valsalva graft and radial position of aortic commissures. Central MessageStraight grafts maintain the radial position of the aortic valve commissures in their native cylindrical conformation, preserving leaflet coaptation and decreasing regurgitation, cusp velocities, and forces. PerspectiveValve-sparing root replacement is an effective treatment for aortic root aneurysms, although the ideal conduit is unknown. While neosinus reconstruction is believed to generate more physiologic flow profiles and optimized hemodynamics, it does not appear to increase longterm clinical durability over straight grafts. Ex vivo testing was used to provide a mechanistic comparison and demonstrated decreased cusp velocities, forces, and regurgitation in straight grafts.

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confidence: 99%

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

Paulsen

Kasinpila

Imbrie-Moore

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…[2][3][4][5][6][7][8] The increasing frequency of a secondary Bentall-De Bono procedure is due to the increasing number of operations being performed on the aortic root, ascending aorta, and aortic arch, and the greater use of bioprosthetic conduits, homografts, and autografts, which are bound to deteriorate, along with an increase in reparative aortic root reconstructions, 9 such as valve-sparing aortic root replacement that may require repeat replacement of the aortic root in the future. 2,4,10,11 Although a primary Bentall-De Bono procedure yields excellent results, as a reoperation, it has traditionally been thought to be associated with high mortality rates due to difficulty in sternal reentry and coronary artery mobilization and reimplantation. The surgical outcomes have improved in recent decades due to various modifications to the original procedure and technological improvements such as the development of new aortic root substitutes, surgical glues, and hemostatic drugs, 12 which have rendered it a safe and reproducible procedure.…”

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confidence: 99%

Primary or secondary Bentall-De Bono procedure: are the outcomes worse?

Kaskar

Bohra

et al. 2019

Asian Cardiovasc Thorac Ann

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Background The aim of this study was to compare the outcomes of a primary and secondary Bentall-De Bono procedure. Methods From 2008 to 2015 (8-year period), 308 patients underwent a Bentall-De Bono procedure in our institute. The mean age was 43 ± 13 years and 80% were men. Twenty-eight patients had prior cardiac surgery through a median sternotomy (group 1) and 280 underwent a primary Bentall-De Bono procedure (group 2). Various preoperative and perioperative parameters were analyzed before and after propensity-score matching. Results Before propensity-score matching, patients undergoing a secondary Bentall-De Bono procedure had a worse preoperative profile, as indicated by a higher EuroSCORE II ( p < 0.0001), with hospital mortality in group 1 of 14% (4/28) and 5% (14/280) in group 2 ( p = 0.069). After propensity-score matching, there was no significant difference in EuroSCORE II ( p = 0.922) or hospital mortality ( p = 0.729). After adjusting for the different variables, repeat sternotomy could not be identified as an independent predictor of postoperative mortality or morbidity. Survival at the end of 1 and 5 years in both groups showed no significant differences before or after propensity-score matching ( p = 0.328 and p = 0.356, respectively). In Cox multivariable regression analysis, reoperation was not identified as an independent factor for survival before ( p = 0.559) or after propensity-score matching ( p = 0.365). Conclusion A secondary Bentall-De Bono procedure can be performed with acceptable mortality and morbidity, and with midterm survival rates comparable to those of a primary Bentall-De Bono procedure.

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Aortic Valve Sparing: Reimplantation Technique

Mignosa¹,

Rubino²

2017

Advances in Treatments for Aortic Valve and Root Diseases

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Midterm follow-up of the reimplantation technique in patients with relatively normal annulus: Is David I still a clinically valid option?

Cited by 4 publications

References 36 publications

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

Modeling conduit choice for valve-sparing aortic root replacement on biomechanics with a 3-dimensional–printed heart simulator

Primary or secondary Bentall-De Bono procedure: are the outcomes worse?

Aortic Valve Sparing: Reimplantation Technique

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