Which Aortic Valve Can Be Surgically Reconstructed?

Abeln, Karen B.; Giebels, Christian; Ehrlich, Tristan; Federspiel, Jan M.; Schäfers, Hans‐Joachim

doi:10.1007/s11886-021-01525-z

Cited by 6 publications

(4 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The degree of AV calcification may influence clinical decision making, and a grading system has been proposed: no calcification is classed as grade 1; small calcification spots (grade 2); larger calcification spots interfering with cusp motion is grade 3; extensive calcification causing restricted cusp motion is grade 4 [ 20 ]. Valve sparing or valve repair surgery is not recommended in cases with moderate or extensive cusp calcification (grades 3 & 4), due to the substantial risk of recurrence of significant AR post valvuloplasty [ 25 , 27 ].…”

Section: Echocardiographic Assessment Of Aortic Regurgitationmentioning

confidence: 99%

Echocardiographic assessment of aortic regurgitation: a narrative review

Tsampasian,

Victor,

Bhattacharyya

et al. 2024

Echo Res Pract

View full text Add to dashboard Cite

Aortic regurgitation (AR) is the third most frequently encountered valve lesion and may be caused by abnormalities of the valve cusps or the aorta. Echocardiography is instrumental in the assessment of AR as it enables the delineation of valvular morphology, the mechanism of the lesion and the grading of severity. Severe AR has a major impact on the myocardium and carries a significant risk of morbidity and mortality if left untreated. Established and novel echocardiographic methods, such as global longitudinal strain and three-dimensional echocardiography, allow an estimation of this risk and provide invaluable information for patient management and prognosis. This narrative review summarises the epidemiology of AR, reviews current practices and recommendations with regards to the echocardiographic assessment of AR and outlines novel echocardiographic tools that may prove beneficial in patient assessment and management.

show abstract

Section: Echocardiographic Assessment Of Aortic Regurgitationmentioning

confidence: 99%

Echocardiographic assessment of aortic regurgitation: a narrative review

Tsampasian,

Victor,

Bhattacharyya

et al. 2024

Echo Res Pract

View full text Add to dashboard Cite

show abstract

“…A prerequisite for a durable AV repair is, however, the presence of pliable cusp tissue. If this is not the case (i.e., in unicuspid stenosis, in bicuspid morphology with marked calcifications and a severely restricted raphe and in bicuspid/tricuspid regurgitation resulting from large fenestrations), the Ross procedure should be primarily planned as repair of these pathologies has been associated with poor long-term results [19]. In fact, the 9 patients from our series that were excluded from the current analysis due to re-do surgery for recurrent severe aortic regurgitation had undergone initial AV repair for the above-mentioned pathologies in the early phase of our series (i.e., during the initial learning curve).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Hemodynamics and Diastolic Function after Native Aortic Valve Preserving vs. Replacing Surgery

Holst,

Hua,

Sinning

et al. 2023

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Background Alterations in left ventricular (LV) diastolic function following native tissue-preserving aortic valve (AV) procedures have not been systematically investigated. Furthermore, no comparisons have been made between these changes and those observed after prosthetic AV replacement. Methods From October 2017 to August 2020, 74 patients aged <65 years were referred to our institution for elective AV surgery. Preoperative and postoperative (i.e., discharge, 3-months and 1-year follow-up) transthoracic echocardiography was analyzed. Results Native tissue-preserving surgery was performed in 55 patients (AV repair: n=42, Ross procedure: n=13). The remaining 19 patients underwent prosthetic AV replacement. Preoperatively and at discharge, transvalvular hemodynamics and LV diastolic function were comparable in both groups. At 1-year follow-up, native valve patients showed significantly lower mean transvalvular gradients (7±5 vs. 9±3 mmHg,p=0.046) and peak velocity (1.74±0.51 vs. 2.26±0.096 m/s,p=0.004) and significantly better septal e’ (9.1±2.7 vs. 7.7±2.5 cm/s,p=0.043) and lateral e’ (14.7±3.1 vs. 11.7±3.7 cm/s,p=0.001). From preoperatively to 1 year postoperatively, septal and lateral e’ and E/e’ improved markedly after native valve preservation (septal e’: +0.7 cm/s,p=0.075; lateral e’: +2.3 cm/s,p<0.001; E/e’: -1.5,p=0.001) but not after AV replacement (septal e’: +0.2 cm/s,p=0.809; lateral e’: +0.8 cm/s,p=0.574; E/e’: -1.2,p=0.347). Significant negative linear correlations between postoperative transvalvular gradients and absolute changes in lateral e’ and E/e’ were detected during follow-up. Conclusion Preservation of native tissue in AV surgery results in superior transvalvular hemodynamics compared to prosthetic AV replacement. This may induce faster LV reverse remodeling and may explain more pronounced improvement in LV diastolic function.

show abstract

“…The incidence of valve-related complications is low, leaving young patients without any functional limitations (9). Parallel to the increasing use of this surgical technique, the understanding of the anatomical and functional mechanisms of AR and aneurysmal dilatation of the aortic root has also improved (10)(11)(12)(13). Functionally, the aortic annulus, cusps, and sino-tubular junction (STJ) contribute to the valvular mechanism.…”

Section: Introductionmentioning

confidence: 99%

Echocardiography of the aortic root: a practical approach for aortic valve-sparing surgery

Lemaire¹,

Vancraeynest²

2023

Ann Cardiothorac Surg

View full text Add to dashboard Cite

Owing to its excellent long-term results, aortic valve-sparing surgery is increasingly used in patients with aortic regurgitation and/or ascending aortic aneurysm. Moreover, in patients with a bicuspid valve who meet the criteria for replacement of the aortic sinuses or aortic regurgitation surgery, valve-sparing surgery may be considered if performed at a comprehensive valve center (Class 2b indication in both the American and European guidelines). Reconstructive valve surgery aims at restoring a normal aortic valve function and a normal aortic root shape as well. Echocardiography plays a central role in defining abnormal valve morphologies, in quantifying aortic regurgitation and mechanisms, and in appreciating tissue valve quality and surgical results. Therefore, despite the emergence of other tomographic techniques, 2D and 3D echocardiography represents the cornerstone for patient selection and prediction of the probability of a reliable repair. The present review focuses on echocardiographic evaluation to detect aortic valve and aortic root abnormalities, to quantify aortic valve regurgitation, to predict aortic valve reparability, and to assess immediate postoperative results in the operating room. Echocardiographic predictors of successful valve and root repair are presented in a practical way.

show abstract

Which Aortic Valve Can Be Surgically Reconstructed?

Cited by 6 publications

References 59 publications

Echocardiographic assessment of aortic regurgitation: a narrative review

Echocardiographic assessment of aortic regurgitation: a narrative review

Hemodynamics and Diastolic Function after Native Aortic Valve Preserving vs. Replacing Surgery

Echocardiography of the aortic root: a practical approach for aortic valve-sparing surgery

Contact Info

Product

Resources

About