Aortic valve repair in type A aortic dissection

Murana, Giacomo; Marco, Luca Di; Botta, Luca; Berardi, Marianna; Costantino, Antonino; Pacini, Davide

doi:10.21037/jovs.2019.09.04

Cited by 2 publications

(6 citation statements)

References 24 publications

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“…Studies examining the role of AVr in ATAAD are limited to single‐institutional experiences from highly specialized centers, of up to 307 patients. In‐hospital mortality in these experiences has ranged from 1% to 21.5% 6,11–14 . This wide range is likely related to a number of patient selection factors and operative techniques used, which remain variable across institutions.…”

Section: Commentmentioning

confidence: 99%

“…F I G U R E 1 National propensity-matched outcomes of aortic valve replacement (AVR) versus aortic valve repair (AVr) at the time of acute type A aortic dissection (ATAAD) 1% to 21.5%. 6,[11][12][13][14] There remains a lack of general consensus regarding the appropriate application of AVr in patients with ATAAD. 6 Decisions regarding valve-sparing operations in this setting involve a careful assessment of patient age, premorbid life expectancy, patient comorbidities, and preferences regarding valve replacement, as well as the extent and severity of the disease.…”

Section: Teaching Status and Hospital Sizementioning

confidence: 99%

“…The most common approach to aortic root pathology in addition to dissection repair has been aortic valve replacement (AVR) with a biologic or mechanical prosthesis 2 . Over the last 20 years, however, there has been increasing focus on the utility of valve preserving techniques in the setting of ATAAD 3–6 . A growing number of studies have reported favorable short‐ and long‐term outcomes with aortic valve repair (AVr) using resuspension and other valve‐sparing techniques.…”

Section: Introductionmentioning

confidence: 99%

“…2 Over the last 20 years, however, there has been increasing focus on the utility of valve preserving techniques in the setting of ATAAD. [3][4][5][6] A growing number of studies have reported favorable short-and long-term outcomes with aortic valve repair (AVr) using resuspension and other valve-sparing techniques. To date, these data have generally been limited to single-center experiences from highly specialized centers.…”

Section: Introductionmentioning

confidence: 99%

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Aortic root management in acute type A aortic dissection: A nationwide analysis

Percy

Harloff

Newell

et al. 2022

Journal of Cardiac Surgery

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Objective Acute type A aortic dissection (ATAAD) is a life‐threatening condition and surgical repair often includes aortic valve replacement (AVR). Aortic valve repair (AVr) is increasingly being reported with favorable outcomes from single‐center experiences. This study examined national trends and outcomes of AVr in patients with ATAAD. Methods Adults with a primary diagnosis of acute thoracic aortic dissection who underwent proximal aortic surgery from January 2016 to December 2017 were obtained from the National Inpatient Sample. Patients were stratified into an isolated aortic surgery group (no aortic valve procedure), concomitant AVR, or concomitant AVr groups. The primary outcome was in‐hospital mortality and secondary outcomes included stroke, acute kidney injury, heart block, and bleeding. Propensity score matching was used to address patient and hospital‐level confounders between AVR and AVr groups. Results In total, 5115 patients underwent surgery for ATAAD and were included. Overall, 3220 (63%) underwent isolated ATAAD repair, while 1120 (22%) had concomitant AVR, and 775 (15%) had concomitant AVr. In 455 propensity‐matched pairs, there was no difference in mortality or stroke between AVr and AVR groups, however, heart block (1.1% vs. 7.5%, p < .001) and bleeding (65.9% vs. 81.3%, p < .001) were significantly less common among those who underwent AVr. Patients who underwent AVr had shortest LOS (11.9 vs. 13.5 days, p < .001). There were no differences in outcomes of AVr in ATAAD based on hospital size or teaching status. Conclusion In selected patients, AVr is being performed safely in the setting of ATAAD with mortality and composite outcomes comparable to AVR.

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Section: Commentmentioning

confidence: 99%

Section: Teaching Status and Hospital Sizementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aortic root management in acute type A aortic dissection: A nationwide analysis

Percy

Harloff

Newell

et al. 2022

Journal of Cardiac Surgery

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“…The Florida Sleeve technique for root remodeling with preservation of the aortic valve and sinuses is a well-established technique for saving the aortic valve while narrowing the annulus and sinotubular junction (12)(13)(14)(15). Allowing the patient to keep their native aortic valve decreases the risk of bleeding issues related to mechanical valves as well as circumvents the potential need for the future re-intervention with a bioprosthetic valve (16). Additionally, the Florida Sleeve root repair technique is a particularly good option in patients who have enlarged aortic root and aberrant coronary anatomy.…”

Section: Introductionmentioning

confidence: 99%

Florida Sleeve for type A dissection

Freeman¹,

Beaver²,

Jeng³

et al. 2021

J Vis Surg

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In properly selected patients, an aortic root repair with valve salvage is a viable alternative to root replacement. Acute type A aortic dissections are often emergency operations with a high complexity. These cases are particularly difficult when the aortic root is enlarged, but the aortic valve leaflets and morphology are normal. In the setting of an acute ascending aortic dissection and enlarged aortic root, preservation of the valve via the use of the Florida Sleeve root repair technique is an alternative to root replacement. We present a case of our standard Florida Sleeve root repair in a patient with an ascending aortic aneurysm of 6.0 cm and an aortic root of 5.3 cm with moderate aortic insufficiency. The patient is a healthy 57-year-old male that had normal trileaflet anatomy but central aortic insufficiency appearing to be related to his root dilation on pre-operative echocardiogram. The Florida Sleeve technique for root remodeling with preservation of the aortic valve and sinuses is a technique for saving the aortic valve while narrowing the annulus and sinotubular junction. Familiarity with root replacement and valve preserving techniques during non-emergency setting is crucial in order to complete the procedure in an efficient manor during an aortic dissection operation.

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Aortic valve repair in type A aortic dissection

Cited by 2 publications

References 24 publications

Aortic root management in acute type A aortic dissection: A nationwide analysis

Aortic root management in acute type A aortic dissection: A nationwide analysis

Florida Sleeve for type A dissection

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