Clinical Outcomes of the David V Valve-Sparing Root Replacement Compared With Bioprosthetic Valve-Conduits for Aortic Root Aneurysms

Esaki, Jiro; Leshnower, Bradley G.; Binongo, José; Lasanajak, Yi; McPherson, LaRonica; Halkos, Michael E.; Guyton, Robert A.; Chen, Edward P.

doi:10.1016/j.athoracsur.2016.09.055

Cited by 33 publications

(14 citation statements)

References 24 publications

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“…Yacoub et al 4 reported 7 (5.83%) perioperative strokes. David et al 13 15 reported 7 thromboembolic events in their first report, although the rate of stroke in the most recent study from David technique was only 3.3%. At least two other studies with the David procedure had only one postoperative stroke.…”

Section: Discussionmentioning

confidence: 97%

“…13 14 A recent report from Emory on the David procedure had a higher operative mortality at 5.7%. 15 However, Ouzounian et al 2 recently updated the Toronto experience with an in-hospital mortality (0.4%). The low rate of early mortality in their study is maybe related to less concomitant cardiac surgery, exclusion of nonelective patients, and a younger patient population.…”

Section: Discussionmentioning

confidence: 99%

“…A study by David et al 13 showed 90% freedom from moderate or severe AI at 5 years. Esaki et al's 15 recent series with the David procedure included 282 patients, and at 7 years, freedom from greater than moderate AI was estimated at 98%. On the other hand, in Yacoub et al's study, 4 17.7% of patients had severe AI prior to surgery and 3% of patients still had severe AI at 5 years.…”

Section: Discussionmentioning

confidence: 99%

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The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Aalaei‐Andabili

Martin

Hess

et al. 2019

Aorta

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Background The Florida (FL) Sleeve procedure was introduced as a simplified approach for valve-sparing correction of functional Type I aortic insufficiency (AI) associated with aortic root aneurysms. In this study, short- and long-term outcomes after the FL Sleeve procedure were investigated. Methods From May 2002 to January 2016, 177 patients underwent the FL Sleeve procedure. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter, left ventricular ejection fraction, and degree of AI (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4) were evaluated by echocardiography. Results Mean ± standard deviation of age was 49.41 ± 15.37 years. Survival rate was 98% at 1 year, 97% at 5 years, and 93% at 8 years. Freedom from reoperation was 99% at 1 year and 98% at 2 to 8 years. Three patients (1.69%) died during hospitalization. Three patients (1.69%) developed periprocedural stroke. Postoperative follow-up echocardiography was available in 140 patients at 30 days, and 31 patients at 5 years. AI grade significantly improved from baseline at 30 days (2.18 ± 1.26 vs. 1.1 ± 0.93, p < 0.001) and at 5 years (2.0 ± 1.23 vs. 1.45 ± 0.88, p = 0.04). Preoperative mean LVEDD significantly decreased from 52.20 ± 6.73 to 46.87 ± 8.40 (p < 0.001) at 30 days, and from 53.22 ± 7.07 to 46.61 ± 10.51 (p = 0.01) at 5 years. Conclusions The FL Sleeve procedure is a safe, effective, and durable treatment of aortic root aneurysm and Type I AI. Long-term survival and freedom from reoperation rates are encouraging.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Aalaei‐Andabili

Martin

Hess

et al. 2019

Aorta

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“…However, an increasing number of high volume cardiac surgery centers recommend aortic valve sparing surgery in the light of improved hemodynamic profile, 69 similar short-to midterm and improved long-term mortality and morbidity. [70][71][72] In a large single center cohort, BAV patients that had undergone either aortic valve replacement or ascending aorta replacement had no root dilatation at midterm follow-up of 8.1 § 5.4 years, negating the need for prophylactic aortic root replacement in these cases. 73…”

Section: Aortic Root and Ascending Aorta Surgerymentioning

confidence: 99%

Re: “Bicuspid Aortic Valve Associated Aortopathy: A Primer for Cardiac Anaesthesiologists”

Lenihan

Vegas

Buys

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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THE RECENT publication of The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy by Borger et al. 1 is the most comprehensive to date after several other publications. 2-5 We aim to provide a short synopsis of these guidelines with a particular focus on the potential implications for cardiothoracic anesthesiologists and the perioperative echocardiographers. Epidemiology Bicuspid aortic valve (BAV) is a common valve pathology with a prevalence of 1% to 2% in the general population; and a male to female predominance of 3:1. 6 It is the most common congenital cardiac lesion worldwide and causes more morbidity and mortality than all other congenital lesions combined. Despite this, appropriately managed patients diagnosed with BAV have a similar life expectancy to the normal population cohort. Valve dysfunction, aortopathy, or aortic dissection may complicate BAV. In addition, other coreported findings with BAV include Turner's and Williams syndromes, abnormal coronary anatomy (nondominant right coronaries adjacent to commissures), aortic coarctation, patent ductus arteriosus, and prolapse of the anterior leaflet of the mitral valve. Aortic valve function may be normal or generally deteriorates over time causing aortic stenosis (AS), aortic insufficiency (AI), or mixed lesions. BAV-AS is the commonest pathology presenting typically in older patients aged 50 to 70 years old, and BAV-AI occurs less often and predominantly in a younger patient cohort. The clinical findings in the BAV patient depend on native valve function and the presence or absence of associated lesions. The initial presentation of BAV varies, as patients may have asymptomatic auscultatory findings, or symptoms of valve dysfunction, bacterial endocarditis, or evidence of an aortic root or ascending aortic aneurysm, or be in extremis with acute aortic dissection. Patients with BAV-AS continue to be asymptomatic for a prolonged period. Those with severe AS may progress to the classic symptoms of dyspnea, decreased exercise tolerance, exertional dizziness, angina, and syncope. Patients with BAV-AI also may remain asymptomatic, though those with severe AI may present with atypical chest pain, palpitations, or dyspnea. Diagnosis The morphology of BAV varies resulting in different phenotypes that relate to the (1) orientation of the open cusps, (2) position of the commissures, and (3) the presence or absence of a raphe. Though several classification systems describe the BAV, the most frequently used is the Sievers' classification (Fig 1). 8 This classification system categorizes BAV into 3 subtypes based on the number of raphe present: Type 0, no raphe (6%), Type 1, one raphe (89%), and Type 2, 2 raphes (5%). Type 1 is the commonest and is further divided by the spatial position of the cusps into left-and right-coronary cusp fusion (71%), right-and noncoronary cusp fusion (15%), and non-and left-coronary cusp fusion (3%). 8 The resulting 2 functional cusps are usually asymmetric in size, and the nonfuse...

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“…For some young patients, the aortic cusps are nearly normal anatomically and morphologically, aortic valve-sparing root replacement was also an effective alternative (Ouzounian et al, 2016). In contrast, recent study provided that valve-sparing root replacement and bio-composite valve led to equivalent operative mortality and morbidity with similar midterm survival and valve durability (Esaki et al, 2017). In emergency situation, aortic valve replacement could be performed to AD patients (Erbel et al, 2014a,b).…”

Section: Aortic Aneurysm and Dissection: Need More Predictors And Timmentioning

confidence: 99%

Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment

Liu

Xie

et al. 2019

Front. Physiol.

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The bicuspid aortic valve, a kind of heart disease that comes from parents, has been paid attention around the world. Although most bicuspid aortic valve (BAV) patients will suffer from some complications including aortic stenosis, aortic regurgitation, endocarditis, and heart dysfunction in the late stage of the disease, there is none symptom in the childhood, which restrains us to diagnose and treatment in the onset phase of BAV. Hemodynamic abnormalities induced by the malformations of the valves in BAV patients for a long time will cause BAV-associated aortopathy: including progress aortic dilation, aneurysm, dissection and rupture, cardiac cyst and even sudden death. At present, preventive surgical intervention is the only effective method used in this situation and the diameter of the aorta is the primary reference criterion for surgery. And the treatment effects are always not satisfactory for patients and clinicians. Therefore, we need more methods to evaluate the progression of BAV and the surgery value and the appropriate intervention time by combining basic research with clinical treatment. In this review, advances in morphology, genetic, biomarkers, diagnosis and treatments are summarized, which expects to provide an update about BAV. It is our supreme expectations to provide some evidences for BAV early screening and diagnosis, and in our opinion, personalized surgical strategy is the trend of future BAV treatment.

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Clinical Outcomes of the David V Valve-Sparing Root Replacement Compared With Bioprosthetic Valve-Conduits for Aortic Root Aneurysms

Abstract: VSRR and BIO result in equivalent operative mortality and morbidity with similar midterm survival and valve durability. VSRR is an effective alternative to BIO for aortic root pathologic conditions; however, careful patient selection is paramount.

Cited by 33 publications

References 24 publications

The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Re: “Bicuspid Aortic Valve Associated Aortopathy: A Primer for Cardiac Anaesthesiologists”

Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment

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