Bicuspid Aortic Insufficiency With Aortic Root Aneurysm: Root Reimplantation Versus Bentall Root Replacement

Vallabhajosyula, Prashanth; Szeto, Wilson Y.; Habertheuer, Andreas; Komlo, Caroline; Milewski, Rita K.; McCarthy, Fenton H.; Desai, Nimesh D.; Bavaria, Joseph E.

doi:10.1016/j.athoracsur.2016.03.087

Cited by 35 publications

(37 citation statements)

References 17 publications

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“…If we exclude the experience of David et al [5], others report excellent long-term results with DP [23][24][25], which is currently our procedure of choice in the treatment of patients with AI and aortic root dilatation. In our series, most patients had a tricuspid aortic valve, but DP can also be employed with similar favorable outcomes in patients with Marfan syndrome or bicuspid aortic valves [11,12,24,25]. For these reasons, we believe that DP should always be planned and attempted in patients with annuloaortic ectasia, whereas MB should be reserved for patients with structural aortic valve disease associated with root dilatation or in cases of early or late DP failure.…”

Section: Discussionmentioning

confidence: 85%

“…Demonstrations that these patients can be treated conservatively by aortic root replacement with an adequately fashioned graft [4] or aortic valve resuspension within a graft tube [3] by valve-sparing procedures restoring adequate aortic valve function have significantly changed the outlook of patients with annuloaortic ectasia. However, given the favorable long-term results of MB [18][19][20], whether valve-sparing operations are superior to composite graft replacement of the aortic root is still a matter of debate [8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Such techniques rapidly became extremely popular and were extensively employed in patients with annuloaortic ectasia, as they have been demonstrated to be reproducible and stable and have excellent long-term results [5,6]. Although the David technique appears to be associated with a better quality of life [7], some controversy remains regarding whether valve sparing is superior to the Bentall operation in terms of overall late results [8][9][10][11][12]. Here, we present the results of a long-term comparison of the two techniques in patients with annuloaortic ectasia.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Annuloaortic Ectasia – Replace or Repair?

Martino¹,

Re²,

Blasi³

et al. 2017

Aorta

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Background: Patients with annuloaortic ectasia may be surgically treated with modified Bentall or David I valve-sparing procedures. Here, we compared the long-term results of these procedures. Methods: A total of 181 patients with annuloaortic ectasia underwent modified Bentall (102 patients, Group 1) or David I (79 patients, Group 2) procedures from 1994 to 2015. Mean age was 62 ± 11 years in Group 1 and 64 ± 16 years in Group 2. Group 1 patients were in poorer health, with a lower ejection fraction and higher functional class. Results: Early mortality was 3% in Group 1 and 2.5% in Group 2. Patients undergoing a modified Bentall procedure had a higher incidence of thromboembolism and hemorrhage, whereas those undergoing a David I procedure had a higher incidence of endocarditis. Actuarial survival was 70 ± 6% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. Actuarial freedom from reoperation was 97 ± 2% at 15 years in Group 1 and 84 ± 7% at 10 years in Group 2. In Group 2, freedom from procedure-related reoperations was 98 ± 2% at 10 years. At last follow-up, no cases of moderate or severe aortic regurgitation were observed. Conclusions: The modified Bentall and David I procedures showed excellent early and late results. The modified Bentall procedure with a mechanical conduit was associated with thromboembolic and hemorrhagic complications, whereas the David I procedure was associated with unexplained occurrences of endocarditis. Thus, the David I procedure appears to be safe, reproducible, and capable of achieving stable aortic valve repair and is therefore our currently preferred solution for patients with annuloaortic ectasia. However, the much shorter follow-up for David I patients limits the strength of our comparison between the two techniques.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Annuloaortic Ectasia – Replace or Repair?

Martino¹,

Re²,

Blasi³

et al. 2017

Aorta

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“…Surgical intervention depends on the clinical presentation [20,21]. Valve repair or replacement for valvular lesions, Bentall procedure for root and ascending aortic dilatation and isolated replacement or repair of the ascending aortas.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Zhu

Zhou

Xiao

et al. 2020

J Cardiothorac Surg

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Background: Evaluate the safety and efficacy of our modified technique of the extravascular procedure for treating mild to moderately dilated ascending aorta in patients with bicuspid aortic valve (BAV) aortopathy. Methods: From January 2015 to December 2018,119 consecutive patients with BAV and ascending aorta dilatation (dimension 40 mm~45 mm) were diagnosed in our institution. Among these,49 patients received aggressive aortic valve replace (AVR) + ascending aorta wrapped (wrapped group) while the other 70 patients received AVR + ascending aorta replacement (wheat group). All patients clinical and follow up data were collected for 12 months. Results: Aortic clamping and cardio-pulmonary bypass times were significantly longer in wheat group than wrap group (P < 0.001and 0.021,respectively). The first 24 h drainage in wheat group were much more than wrap group(P = 0.04). Ascending aorta diameter、left ventricular end diameter and ejection fraction were statistically different between pre-and post-operation (p < 0.001) in both groups, but the heart function and complication were no difference during follow up. Conclusions: External wrapping of the ascending aorta and wheat procedure have good short-term and long-term results in BAV patients with a mild to moderately dilated ascending aorta. The perioperative period results of external wrapping of the ascending aorta for BAV patients were encouraging.

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“…Three primary types of valve leaflet repair and annular reduction/root stabilization techniques include SCA, ESAR, and VSRR. Although BAV patients initially have a high grade of AI that requires concomitant primary valve repair, VSRR has excellent midterm outcomes comparable with the Bentall procedure [14,22].…”

Section: Commentmentioning

confidence: 99%

Predictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair

Habertheuer

Milewski

Bavaria

et al. 2018

The Annals of Thoracic Surgery

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Bicuspid Aortic Insufficiency With Aortic Root Aneurysm: Root Reimplantation Versus Bentall Root Replacement

Abstract: In patients with bicuspid aortic valve AI with root aneurysm, primary cusp repair with root reimplantation achieves equivalent midterm outcomes compared with Bentall root replacement.

Cited by 35 publications

References 17 publications

Surgical Treatment of Annuloaortic Ectasia – Replace or Repair?

Surgical Treatment of Annuloaortic Ectasia – Replace or Repair?

Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Predictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair

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