Valve-sparing aortic root replacement in patients with Marfan syndrome—the Homburg experience

Schneider, Ulrich; Ehrlich, Tristan; Karliova, Irem; Giebels, Christian; Schäfers, Hans‐Joachim

doi:10.21037/acs.2017.11.01

Cited by 18 publications

(13 citation statements)

References 24 publications

(28 reference statements)

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“…For a long time, the main discussion about VSRR technique was around the question of remodeling versus reimplantation. Overall, long-term results following both procedures are excellent (27,37,38). Nevertheless, early results suggested higher rates of reintervention in patients who underwent a remodeling procedure (6,39,40).…”

Section: Surgical Techniquementioning

confidence: 97%

Aortic valve sparing surgery—patient selection and techniques

Chauvette¹,

Chamberland²,

Lefebvre³

et al. 2021

J Vis Surg

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Aortic valve sparing root replacement (VSRR) is an attractive alternative to composite graft replacement in young patients with root aneurysms. The preservation of a native aortic valve provides more physiologic hemodynamics, avoids the complications associated with valve replacement and is associated with excellent long-term survival. However, this has to be weighed against the risk of reintervention due to valve repair failure in specific patients. This can be optimized through careful patient selection and surgical technique. The aim of this article is to review these important considerations for planning VSRR.

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Section: Surgical Techniquementioning

confidence: 97%

Aortic valve sparing surgery—patient selection and techniques

Chauvette¹,

Chamberland²,

Lefebvre³

et al. 2021

J Vis Surg

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“…tissue disease, such as Marfan's syndrome 27 ; it may also apply to patients with preexistent root dilatation. 8 In these cases, primary aortic root replacement appears reasonable to decrease the potential risk of future proximal reoperation.…”

Section: Thoracic and Cardiovascular Surgeonmentioning

confidence: 99%

Aortic Root Remodeling in Acute Aortic Dissection

Ehrlich

Karliova

Froede

et al. 2020

Thorac Cardiovasc Surg

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Objectives To evaluate the long-term results of remodeling in acute aortic dissection type A (AADA) to define operative risk and root and valve stability. Methods Between October 1995 and December 2018, a total of 352 patients were treated surgically for AADA. Of these, 90 patients with AADA (<2 weeks from onset; age: 57 ± 15 years; 70 males) with a root diameter of >43 to 45 mm (depending on patient size) (48 ± 4.1 mm) underwent aortic root remodeling and were analyzed further. As the control group, we chose the patients with normally sized aortic roots who had been treated by tubular replacement only (n = 227). Other procedures were performed in 35 cases. Results Early mortality was 9% in the remodeling group versus 15% in the tubular ascending aortic replacement (TAR). Actuarial survival at 10 and 15 years was 68 ± 5% and 58.3 ± 6.4%, respectively, in the root remodeling group versus 68 ± 4% and 66 ± 4% in the TAR group (p = 0.99). Freedom from reoperation on the aortic valve or root was 95 ± 3% at 10 years and at 89 ± 6% at 15 years. Freedom from proximal reoperation after TAR at 10 and 15 years was 93 ± 3% and 91 ± 3% (n = 31 patients at risk), respectively, not statistically different from that after remodeling (p = 0.75). Conclusions The long-term stability of aortic root remodeling for enlarged roots with AADA was comparable to TAR preserving a normal aortic root.

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“…18 The excellent durability of David has not been reproduced by others 18 including our own results. 3,12 This brings up the question to what degree preoperative patient selection rather than the superiority of the technique 20 has been a strong determinant of functional results. In fact, we have not seen any evidence of long term superiority of reimplantation over root remodeling.…”

Section: Annuloplastymentioning

confidence: 99%

“…In fact, we have not seen any evidence of long term superiority of reimplantation over root remodeling. 3,12 In direct comparison root remodeling has been the procedure that requires less dissection (at least if done without a ring annuloplasty) and shorter ischemic times. This is particularly so if muscle extension into the sinus is present; in that scenario reimplantation would require very deep dissection, 21 which is feasible but traumatic.…”

Section: Annuloplastymentioning

confidence: 99%

“…10 This combination has led to a higher proportion of competent aortic valves 11 and a slight trend to improved freedom from reoperation also with connective tissue disease. 12 Compared to valve reimplantation, root remodeling requires less dissection, especially in the presence of muscle in the right sinus. Cross-clamp times have been significantly shorter than those of valve reimplantation or also remodeling combined with an extraaortic ring 7,13,14 ; we have not seen increased incidence of hemorrhage, even in acute aortic dissection.…”

Section: Introductionmentioning

confidence: 99%

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Aortic Root Remodeling

Schneider

Schäfers

2018

Operative Techniques in Thoracic and Cardiovascular Surgery

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Valve-preserving aortic root replacement has become an attractive alternative to composite replacement leading to better quality of life and minimal valve-related complications. Root remodeling requires less surgical dissection and has been shown to lead to more physiological hemodynamics compared to valve reimplantation. Over the last 2 decades, improvements have been made regarding assessment of cusp and root configuration. Aggressive correction of cusp prolapse extended the application of root remodeling to a larger patient population and has markedly improved valve stability, even in patients with connective tissue disorders. In the presence of annular dilatation, the addition of an annuloplasty has been shown to be beneficial for valve competence and repair durability. Aortic root remodeling combined with cusp repair and correction of annular dilatation leads to excellent valve stability and minimal valve-related complications. Operative Techniques in Thoracic and Cardiovasculary Surgery 23:102À120

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Valve-sparing aortic root replacement in patients with Marfan syndrome—the Homburg experience

Cited by 18 publications

References 24 publications

Aortic valve sparing surgery—patient selection and techniques

Aortic valve sparing surgery—patient selection and techniques

Aortic Root Remodeling in Acute Aortic Dissection

Aortic Root Remodeling

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