Aortic Root Remodeling in Acute Aortic Dissection

Ehrlich, Tristan; Karliova, Irem; Froede, Lennart; Giebels, Christian; Kunihara, Takashi; Schäfers, Hans‐Joachim

doi:10.1055/s-0040-1718937

Cited by 6 publications

(2 citation statements)

References 27 publications

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“…The current series includes different indications, i.e., aneurysm, severe AR, acute aortic dissection and connective tissue disease. Early mortality was low (1.5%) despite the inclusion of patients with acute aortic dissection ( 44 ). Similarly, we observed a low morbidity.…”

Section: Discussionmentioning

confidence: 99%

Remodeling of the aortic root—a 28-year journey

Abeln¹,

Ehrlich²,

Froede³

et al. 2023

Ann Cardiothorac Surg

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Background: Root remodeling is one form of valve-preserving root replacement for aortic regurgitation and root aneurysm. The objective of this review was to summarize our experience with root remodeling encompassing 28 years.Methods: We performed root remodeling in 1,189 patients (76% male, mean age 53±14 years) between October 1995 and September 2022. The original valve morphology was unicuspid in 33 (2%), bicuspid in 472 (40%) and tricuspid in 684 (58%) patients. Fifty-four patients (5%) had Marfan's syndrome. Objective measurement of valve configuration was performed in 804 (77%) and an external suture annuloplasty was added in 524 patients (44%). Cusp repair was performed in 1,047 (88%) patients, most commonly for prolapse (n=972; 82%). Mean follow-up was 6.7±5.5 years [1 month to 28 years]. Follow-up was 95% complete (7,700 patient-years).Results: Survival was 71% at 20 years; freedom from cardiac death was 80%. Freedom from aortic regurgitation ≥2 was 77% at 15 years. Freedom from reoperation was 89% and was higher in tricuspid aortic valves (94%) compared to bicuspid (84%) and unicuspid valves (P<0.001). Since the introduction of effective height measurement, freedom from reoperation has remained stable at 15 years (91%). With the addition of a suture annuloplasty, freedom from reoperation was 94% at 12 years. The difference with or without annuloplasty (91%) was not significant (P=0.949).Conclusions: Root remodeling is a viable option in valve-preserving root replacement. Concomitant cusp prolapse is frequent and can be corrected reproducibly by intraoperative measurement of effective height.The long-term benefit of an annuloplasty still needs to be defined.

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Section: Discussionmentioning

confidence: 99%

Remodeling of the aortic root—a 28-year journey

Abeln¹,

Ehrlich²,

Froede³

et al. 2023

Ann Cardiothorac Surg

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“…Several expert groups report their experience over decades. 51 52 53 They all describe excellent long-term outcomes for valve repair/reimplantation associated with low rates of re-intervention and valve-related complications (VRCs). The only replacement option demonstrating similar long-term outcomes with low rates of re-intervention and VRC appears to be the Ross procedure (in dedicated centers with high expertise).…”

Section: Surgical Treatment Of Valve Diseasementioning

confidence: 99%

Cardiac Surgery 2023 Reviewed

Kirov,

Caldonazo,

Mukharyamov

et al. 2024

Thorac Cardiovasc Surg

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We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term “cardiac surgery AND 2023.” We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.

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