Successful Replacement of the Entire Ascending Aorta and Aortic Valve

Wheat, Myron W.; Wilson, James R.; Bartley, Thomas D.

doi:10.1001/jama.1964.03060340015004

Cited by 161 publications

(46 citation statements)

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“…Since Wheat reported a successful replacement of the subtotal ascending aorta and aortic valve without coronary reimplantation in 1964, 1) 3 main types of replacement of the entire ascending aorta and aortic valve with coronary reanastomosis have appeared. [2][3][4][5] These are now preferred because of the potential advantage of excluding the entire abnormal aorta from the aortic annulus to the innominate artery.…”

Section: Discussionmentioning

confidence: 99%

Long Term Results With the Cabrol Aortic Root Replacement

et al. 2011

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SummaryCabrol aortic root replacement is rarely performed in recent years because of potential coronary complications. The purpose of this study was to investigate its early and late results, including coronary complications, by evaluating our experience thus far. A retrospective lookup of patients who underwent Cabrol aortic root replacement between 1988 and 2001 found a total of 36 patients (24 men and 12 women) with a mean age of 45 years. Annuloaortic ectasia was the most frequent cause (n = 22), followed by chronic dissection (n = 5), acute dissection (n = 5), and aneurysm with prior aortic operation (n = 4). Early mortality occurred in one patient (2.8%). The mean follow-up period was 104 months. There were 7 late deaths, 4 of which were disease-related. The actuarial survival was 83.3% at 5 years and 72.9% at 10 years, and the freedom from reoperation was 87.9% at 5 years and 76.6% at 10 years. There were no reoperations on the ascending aorta. Coronary ostia were examined by angiography or 64-row multidetector computed tomography in 18 patients 43 to 189 months after the operation. Two patients developed stenosis or occlusion of the right coronary ostium. The early and late results of the Cabrol operation were favorable with the exception of coronary complications. The importance of careful follow-up for late coronary complications cannot be overemphasized. ( 1) The Bentall operation features an inclusion/wrapping technique together with direct reanastomosis of the coronary ostia.2,3) In the Cabrol operation, the coronary arteries are reconstructed with a looped interposing tube graft between the ostia. 4) In the 'button' technique, the coronary ostia are excised and directly reanastomosed.5) Recently, the Bentall and Cabrol procedures have less frequently been used because of better late results with the button technique and, accordingly, Cabrol root replacement has become obsolete. We also changed our strategy for aortic root replacement from the Cabrol operation to the button technique in 2001. In this report, we present our experience with the Cabrol procedure to shed light upon its early and late results, including coronary complications. MethodsPatients: From September 1998 to October 2001, 36 patients underwent Cabrol root replacement in our unit. The medical records of subjects were reviewed with respect to patient preoperative demographics, diagnosis, surgical procedural data, and outcomes. Recent events were also obtained from the referring cardiologists and the patients by telephone and written inquiries. Operative procedure: Through standard median sternotomy, cardiopulmonary bypass (CPB) was established using moderate systemic hypothermia (26 °C to 28 °C) unless concomitant aortic arch replacement with profound hypothermia was present. Potassium-induced crystalloid cardioplegia was given directly into the coronary ostia. Coronary anastomoses were performed using doubly pledgetted (Dacron sheet and polyester tube) 3-0 polyester interrupted mattress sutures (Figure 1a), and aortic anastomoses ...

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Section: Discussionmentioning

confidence: 99%

Long Term Results With the Cabrol Aortic Root Replacement

et al. 2011

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“…In 1962, Wheat first performed aortic valve replacement with simultaneous replacement of the ascending aorta (Wheat et al, 1964). In this patient, the aortic valve was replaced with a Starr-Edwards prosthesis, and the ascending aorta with a separate graft, leaving in place only two small tongues of aorta corresponding to the left and right coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

“…Possible etiologies include cystic medial degeneration (Pomerance et al, 1977). atherosclerosis (McCready and Pluth, 1979;Narsallah et al, 1975), syphilitic aortitis (Pomerance et al, 1977;Wheat et al, 1964), giant cell aortitis (Austen and Blennerhassett, 1965;Helseth et al, 1973), nonspecific aortitis (Pomerance et al, 1977), senile degeneration of the aorta (Ferlic et al, 1967), trauma (Ferlic et al, 1967), yaws (Singh and Bentall, 1972). and idiopathic dilation of the aortic root (Helseth et al, 1973).…”

Section: Introductionmentioning

confidence: 99%

The surgical experience with annuloaortic ectasia at the medical university of south carolina

Clevenger

Crawford

1986

Clinical Cardiology

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Summary: Hemodynamically significant aortic insufficiency can result from dilitation of the aortic valve annulus in association with an ascending aortic aneurysm (annuloaortic ectasia). Controversy has centered around the optimal surgical management. This study evaluates the results of total replacement of the aortic valve and ascending thoracic aorta with a valved aortic prosthesis and reimplantation of the coronary arteries in a small series. In 7 patients with a mean preoperative New York Heart Association Classification (NYHAC) of 111, there have been no operative or long-term mortalities, and the average upgrade in NYHAC is 1.6. There have been no major cornplications or technical difficulties. The composite approach to the repair of patients with annuloaortic ectasia is described and advocated.

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“…The conservative surgical treatment for an ascending aorta aneurysm takes its origin not as an elective treatment of mild or moderate dilatation of the ascending aorta, but as a surgical alternative to the traditional radical technique of resection with a tubular (Wheat et al, 1964;Ggoves et al, 1964) or a tubular valvular graft (Bentall & De Bono, 1968;Cabrol et al, 1986) (Figure 1). Fig.…”

Section: Conservative Treatment Of An Ascending Aorta Aneurysmmentioning

confidence: 99%