Valve-Sparing Aortic Root Reconstruction
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Keywords:
Root (linguistics)
Aortic valve repair
Aortic Valve Insufficiency
Bentall procedure
Either the Bentall-De Bono operation or the valve-sparing aortic root replacement is commonly chosen for aortic root management. However, if the preoperative condition is poor, a simpler technique is preferred; therefore, we performed hemi-root replacement with diagonal resection of the aortic root preserving the left coronary sinus of Valsalva. Because reimplantation of the left coronary artery is not required, this technique may shorten operative time and reduce coronary malperfusion, a condition characterized by reduced transit flow time and reduced cardiac contractility.
Bentall procedure
Aortic Valve Insufficiency
Contractility
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The Bentall procedure is a reliable treatment of various types of aortic root pathology. Furthermore, the aortic valve-sparing aortic root replacement also has been accepted as an ideal procedure especially in young patients. Recently, we have developed a simple valve-sparing operation focused on standardization and reproducibility.From 2011 to 2017, 44 consecutive patients underwent aortic root replacement( Bentall 17, David 27)in our institution. Surgical results of these patients were evaluated retrospectively. Geometric parameters of reconstructed aortic root were analyzed to evaluate aortic valve function.There were 2 operative death( Bentall 2, David 0). Valve-sparing procedure was completed without conversion to valve replacement and no significant aortic insufficiency was noted soon after the operation. Patients underwent David operation were divided into 2 groups according to the annular diameter. There were 15 patients with large annulus and 12 with small annulus. The postoperative valve function was reproduced in both large and small annulus groups. From the results of geometric analysis of the aortic root, patients with large annulus and sino-tubular(ST) junction were anatomically more suitable and better treated with reimplantation technique. On the other hand, even in patients with small annulus, effective plication of ST junction and adequate suspension of commissure posts might be contribute to restore the valve competency with reimplantation technique. Two patients had aortic valve replacement 6 and 12 months after reimplantation, respectively.The acceptable outcome was demonstrated in patients underwent aortic root replacement. Aortic valve was reproduced well with our simple modification of valve-sparing operation. Although our modified technique is considered to be safe, reproducible and technically less demanding, close observation would be mandatory in this particular circumstance.
Cardiac skeleton
Bentall procedure
Aortic valve repair
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We evaluated retrospectively 11 consecutive patients who underwent emergent aortic root operations for acute aortic dissection from April 2012 to March 2017. We underwent Bentall operation in 6 patients and Florida Sleeve repair in 3 patients and aortic root replacement with a Freestyle stentless porcine valve in 2 patients. The 30-day mortality of emergent aortic root operations was 9.1%(1 of 11), and the hospital mortality was 18.2%(2 of 11). The Overall survival at 5 years was 90.0%. In conclusion, the aortic root repair can be performed safely in acute aortic dissection.
Bentall procedure
Aortic valve repair
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Based on the natural mathematical relationships between the components of the human tri-leaflet aortic valve, new calibrated cusp sizers were developed in order to facilitate aortic valve assessment in the operating room and enhance the chance for a perfect restoration of aortic valve competence. These sizers were used clinically to guide the implementation of established aortic valve repair techniques in 10 consecutive patients with severe aortic valve regurgitation. Valve repair was successful in all cases, and at a median follow-up was 5.5 months, aortic valve function remained stable, with aortic regurgitation ≤1+ in every patient and no significant gradient across the aortic valves. This preliminary clinical experience indicates that the calibrated cusp sizers can provide reliable insight into the mechanism of aortic valve insufficiency, and can guide aortic valve repair techniques successfully. We hope that the simplicity and reproducibility of this method would assist in its dissemination and further increase the percentage of aortic valves that are repaired when compared with current practice.
Aortic valve repair
Aortic Valve Insufficiency
Aortic valve regurgitation
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Background: The study was aimed at investigating the mathematical relationship between the aortic valve and aortic root through CTA imaging-based reconstruction. Methods: We selected 121 healthy participants and analyzed the measurements of aortic root dimensions, including the sinotubular junction (SJT), ventriculo-arterial junction (VAJ), maximum sinus diameter (SD), sinus height (SH), effective height (eH) and coaptation height (cH). We also reconstructed 3-D aortic valve cusps using CTA imaging to calculate the aortic cusp surface areas. Data were collected to analyze the ratios and the correlation between aortic valve and aortic root dimensions. Results: Among healthy participants, the STJ was approximately 10% larger than the VAJ, and the SD was 1.375 times larger than the VAJ. The average eH and cH were 8.94 mm and 3.62 mm, respectively. The aortic cusp surface areas were larger in men than women. Regardless of sex, the non-coronary cusp was found to be largest, and was followed by the right coronary cusp and the left coronary cusp. Although the aortic root dimensions were also significantly larger in in men than women, the STJ to VAJ, SD to VAJ, and SH to VAJ ratios did not significantly differ by sex. The mathematical relationship between the aortic cusp surface areas and VAJ orifice area was calculated as aortic cusp surface areas Conclusions: The aortic root has specific geometric ratios. The mathematical relationship between the aortic valve and aortic root might be used to guide aortic valve repair.
Aortic sinus
Aortic valve repair
Body surface area
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The aortic root has a unique 3-dimensional configuration and the distinctive function of supporting the aortic valve and blood vessels. The sinuses of Valsalva are crucial to create appropriate eddy currents that are important in initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Most aneurysms in the aortic root are associated with degenerative changes in the elastic media rather than atherosclerosis. Valve-sparing root repair has become widely accepted, although the Bentall procedure remains the gold standard. Because reimplantation using the Valsalva graft allows root geometry to be retained and theoretically and practically prevents recurrent aortic valve regurgitation, it is considered the most reliable and preferred technique among various valve-sparing aortic root repair procedures.
Bentall procedure
Aortic valve regurgitation
Aortic valve repair
Aortic Valve Insufficiency
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Objectives: The main goal in aortic valve-sparing root surgery is to ensure durable aortic valve function without re-intervention. Since the optimal procedure in aortic root surgery remains undefined, the aim of this study was to compare the outcomes of valve-sparing root surgery and Bentall procedures in patients with aortic root aneurysms.
Bentall procedure
Aortic valve repair
Single Center
Aortic surgery
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Background Quantitative 3D assessment of the aortic root may improve planning and success of aortic valve ( AV )‐sparing operations. Aims To use 3D transesophageal echocardiography ( TEE ) to assess the effect of chronic aortic dilatation on aortic root shape and aortic regurgitation ( AR ) severity and to examine the effects of AV ‐sparing operations. Methods and Results To determine the changes with chronic aortic dilatation, we studied 48 patients, 23 with aortic dilatation (Group 1 ≤ mild AR , n = 13; Group 2 ≥ moderate AR , n = 10) and 25 Controls. To determine the changes in AV ‐sparing operations, a subgroup of 15 patients were examined pre‐ and post surgery. 3D‐ TEE images were analyzed using multiplanar reconstruction ( QLAB , Philips, Philips Medical Systems, Andover, MA, USA) to obtain aortic root areas, diameters, and lengths. We also calculated a novel parameter called total coaptation surface area ( TC oap SA ), which sums the contact surface area of all the AV cusps. Compared to Controls, Groups 1 and 2 had significantly larger aortic root areas, inter‐commissural distances, and cusp heights. Compared to Group 1 and Controls, Group 2 had significantly smaller TC oap SA when adjusted for aortic annular area ( P = 0.001) with shorter coaptation height ( P < 0.001). In patients undergoing AV ‐sparing surgery, TC oap SA was significantly larger post surgery ( P = 0.001) with greater coaptation height ( P < 0.001) and smaller inter‐commissural distances ( P < 0.001). Conclusions The aortic valve is a dynamic structure that remodels in response to aortic dilatation. Successful valve‐sparing surgery corrects these changes. Quantitative modeling of the aortic valve and root could potentially improve the repair to the individual patients and modify outcomes.
Aortic valve repair
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We evaluated retrospectively 11 consecutive patients who underwent emergent aortic root operations for acute aortic dissection from April 2012 to March 2017. We underwent Bentall operation in 6 patients and Florida Sleeve repair in 3 patients and aortic root replacement with a Freestyle stentless porcine valve in 2 patients. The 30-day mortality of emergent aortic root operations was 9.1％（1 of 11）, and the hospital mortality was 18.2％（2 of 11）. The Overall survival at 5 years was 90.0％. In conclusion, the aortic root repair can be performed safely in acute aortic dissection.
Bentall procedure
Aortic valve repair
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Objective: The optimal treatment of acute aortic dissection type A (AADA) with involvement of the aortic root is controversial. In addition to classical Bentall procedure, valve-sparing David procedure is an alternative. The purpose of this study was to compare the outcome of these surgical approaches.
Bentall procedure
Gold standard (test)
Aortic valve repair
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Citations (11)