Surgical anatomy of the aortic root: Implication for valve-sparing reimplantation and aortic valve annuloplasty

Kerchove, Laurent de; Jashari, Ramadan; Boodhwani, Munir; Duy, Khanh Tran; Lengelé, Benoît; Gianello, Pierre; Nezhad, Zahra Mozala; Astarci, Parla; Noirhomme, Philippe; Khoury, Gébrine El

doi:10.1016/j.jtcvs.2014.09.042

Cited by 93 publications

(88 citation statements)

References 25 publications

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“…The ring was implanted above the AB on average 2 mm in the right coronary nadir, 0 mm in the left coronary, and 2 mm below the AB in the noncoronary nadir, remaining stable in the follow-up. These measurements correlate very closely with the data of two anatomic studies published by Khelil and colleagues [17] and de Kerchove and colleagues [18]. Beside these findings, the study showed the annuloplasty to be effective and stable in follow-up, confirmed as well by clinical data.…”

Section: Commentsupporting

confidence: 87%

“…The limit of proximal dissection of the aortic root corresponds to the external aspect of the VAJ, and recently a refinement of the VAJ definition has been done, describing that this is not a planar circle strictly above the AB as initially thought. The VAJ is a three-dimensional curvilinear circle partially at the level of the AB and partially above (Fig 1) [17,18]. In this study, where aortic root remodeling with the implantation of an external aortic annuloplasty ring has been performed, the VAJ serves as a "landing zone" for the annuloplasty ring; therefore, we aimed to call it annuloplasty ring base (ARB).…”

Section: Definition Of Aortic Annulusmentioning

confidence: 99%

“…The goal of circumferential annuloplasty is to target the AB, and for that the aortic root should be dissected until reaching the AB. This has been reported to be not fully feasible, whereas the limit of proximal dissection of the aortic root corresponds to the external aspect of the VAJ [15][16][17][18]. The VAJ, in fact, serves as a "landing zone" for the external annuloplasty ring.…”

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Holubec

Higashigaito

Bëlobrádek

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 87%

Section: Definition Of Aortic Annulusmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Holubec

Higashigaito

Bëlobrádek

et al. 2017

The Annals of Thoracic Surgery

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“…However, Ann Cardiothorac Surg 2017;6(6):682-691 www.annalscts.com the external extent of mobilization of the aortic root does not always parallel this desirable internal line. This is particularly so in the region of the right ventricular outflow tract (RVOT), which may insert into the right sinus at a higher level (6).…”

Section: Annular Suturesmentioning

confidence: 99%

Aortic valve sparing root surgery for Marfan syndrome

Matalanis

Perera

2017

Ann. Cardiothorac. Surg.

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Aortic valve sparing root surgery (AVSRS) is a safe and durable alternative for patients with dilated roots or pure aortic regurgitation (AR), which avoids the risks of anticoagulation or valvular degeneration with prosthetic valves. Notwithstanding the theoretical challenges of greater tissue fragility in Marfan syndrome (MFS), AVSRS has been demonstrated to have equal outcomes in this condition as it does in those without MFS. The benefits of retaining the native aortic valve in this generally younger age group extend beyond those of avoiding the inconvenience and complications of prolonged exposure to anticoagulants and include ease of management for future aortic, cardiac and non-cardiac procedures which are the norm for these patients. The essential principles of AVSRS in MFS do not differ from those for the rest of the population.Successful repair and durable valve function depend on a sound understanding of the close interaction between the structure and function of this exquisitely designed piece of engineering. We are fortunate to have numerous tools in our surgical armamentarium to preserve these valves. It is the purpose of this paper to demystify the complex structure-function interactions of the aortic valve, thereby gaining an intuition for AVSRS. We will also elaborate on specific technical details of established techniques that we have found successful in preserving the normal function of these valves in the long term.

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“…The height of the root extends externally from the sinotubular junction to the ventricular-arterial junction and internally from the sinotubular junction to the basal ring defined by the plane passing through the cusps base [13]. To make sure that every root component is maintained intact after the decellularization fixation method, the dissection should be extend beyond these limits.…”

Section: Aortic Root Removal and Myocardial Processingmentioning

confidence: 99%

A Standardized Dissection Protocol to Generate Aortic Valvular Scaffolds from Porcine Hearts

Movileanu

Harpa

Brânzaniuc

et al. 2017

Acta Medica Marisiensis

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Objective: To describe a particular harvesting procedure for isolating intact porcine aortic heart valve roots as potential sources for biologic scaffolds. Methods: Fresh porcine hearts were brought to the Tissue Engineering and Regenerative Medicine Laboratory at the University of Medicine and Pharmacy in Targu Mures. The aortic roots were extracted from the porcine hearts by anatomical dissection. For this purpose, we used a basic surgical instrument kit. This initial phase was the first step in obtaining acellular extracellular matrix as a biologic scaffold material. Results: Aortic roots were isolated with preservation of the ascending aorta as well as the intact aortic sinus and coronaries together with the adjacent myocardial tissue and anterior leaflet of the mitral valve. This approach allowed for safe mounting of roots into mounting rings for perfusion decellularization. Conclusions: The described procedure is a feasible protocol for obtaining intact biological valvular scaffolds from porcine hearts. Reduced requirements regarding tools and personnel underline the easiness of aortic root harvesting using this particular procedure.

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Surgical anatomy of the aortic root: Implication for valve-sparing reimplantation and aortic valve annuloplasty

Cited by 93 publications

References 25 publications

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Aortic valve sparing root surgery for Marfan syndrome

A Standardized Dissection Protocol to Generate Aortic Valvular Scaffolds from Porcine Hearts

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