Clinical outcomes of valve-sparing root replacement in acute type A aortic dissection

Lee, Heemoon; Cho, Yang Hyun; Sung, Kiick; Kim, Wook Sung; Park, Kay-Hyun; Park, Pyo Won; Lee, Young Tak

doi:10.3109/14017431.2015.1072236

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…In patients who had aortic regurgitation combined with aortic root dilation, aortic root reimplantation or replacement can be aggressively performed according to the pathology of the aortic valve during the initial procedure [ 13 , 25 ]. Aortic root surgery associated with acute type A aortic dissection surgery did not affect surgical outcomes of acute dissection surgery [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

Choi

Kim

et al. 2018

THC

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BACKGROUND: Despite recent advances in surgical techniques and perioperative management, the surgical mortality of acute type A aortic dissection remains high.OBJECTIVE: In a hospital with few acute type A aortic dissection operations, we retrospectively investigated whether simplified surgical approach could obtain proper surgical outcomes.METHODS: Between October 2007 and December 2016, we performed emergency surgery in 99 patients who had acute type A aortic dissection, including replacement of the hemi-arch in 62 patients (63%) and total arch in 32 patients (32%) and aortic root surgery in 7 patients (7%). Surgical strategy has been simplified over time.RESULTS: We performed right axillary artery perfusion in 61 patients (62%) and antegrade cerebral perfusion in 78 patients (79%). During the last 3 years, in-hospital mortality was decreased to 4% (2/47). Preoperative unresolved shock was an independent predictor of hospital death. Although the patients with total arch replacement or aortic root surgery had a mean significantly long cardiopulmonary bypass or circulatory arrest time, in-hospital mortality or neurologic complications was not increased.CONCLUSIONS: Simplified surgical approach could provide a reasonable surgical outcome in acute type A aortic dissection surgery in a center with a small volume of acute aortic dissection surgery.

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Section: Discussionmentioning

confidence: 99%

Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

Choi

Kim

et al. 2018

THC

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“…5 There are several reports of VSRR techniques in ATAAD with acceptable early and long term results. 3,[6][7][8] However, the surgical complexity of VSRR and the longer cross-clamp time has slowed wider adoption in the emergent setting. 9 The Florida sleeve (FS) procedure is a simplified valve sparing root repair that does not require coronary artery reimplantation.…”

Section: Introductionmentioning

confidence: 99%

“…For dissections involving the aortic root, the Bentall procedure has traditionally been considered the gold standard owing to its technical feasibility and reproducibility 5 . There are several reports of VSRR techniques in ATAAD with acceptable early and long term results 3,6–8 . However, the surgical complexity of VSRR and the longer cross‐clamp time has slowed wider adoption in the emergent setting 9 …”

Section: Introductionmentioning

confidence: 99%

Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection

Alhussaini

Jeng

Martin

et al. 2021

Journal of Cardiac Surgery

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Objective Valve‐sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute type‐A aortic dissection (ATAAD). The Florida sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the FS repair in patients with dilated roots in the setting of an ATAAD. Methods We retrospectively reviewed 24 consecutive patients (2002–2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow‐up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal‐perfusion or shock. The FS was combined with hemi‐arch replacement in 15 (62.5%) patients and a zone‐2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow‐up period was 46 months (range, 0.3–146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion FS is simplified and reproducible valve‐sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type‐A aortic dissection with excellent early and long‐term results.

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“…For dissections involving the aortic root, the Bentall procedure has traditionally been considered the gold standard owing to its technical feasibility and reproducibility (5). There are several reports of VSRR techniques in ATAAD with acceptable early and long term results (3,(6)(7)(8). However, the surgical complexity of VSRR and the longer cross-clamp time has slowed wider adoption in the emergent setting (9).…”

Section: Introductionmentioning

confidence: 99%

Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

Alhussaini

Jeng

Martin

et al. 2021

Preprint

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Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

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Clinical outcomes of valve-sparing root replacement in acute type A aortic dissection

Abstract: VSR seems to be equivalent to the Bentall procedure for AAD in terms of early and late outcomes. VSR can be considered as a viable option, particularly for young patients with favorable aortic valve leaflets undergoing surgery at an experienced center.

Cited by 10 publications

References 27 publications

Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection

Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection

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