Comparison of Three Different Surgical Methods in Aortic Root Aneurysms: Long‐Term Results

Çaynak, Barış; Sağbaş, Ertan; Onan, Burak; Onan, Ismihan Selen; Şen, Onur; Bayramoğlu, Zehra; Kabakci, Birol; Sanisoglu, Ilhan; Akpınar, Belhhan

doi:10.1111/j.1540-8191.2009.00928.x

Cited by 6 publications

(4 citation statements)

References 13 publications

(34 reference statements)

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“…Besides this, we selectively replace NCS if we find an asymmetric dilation of the NCS rather than circumferential root dilation. Even if these data are similar to a smaller cohort by Caynak et al 17 (which analyzed 99 patients, and compared surgical results between those who underwent Bentall and NCS replacement), we still think that the Bentall operation is a complex procedure even in experienced hands: CPB times are usually longer, intraoperative bleeding and kinking of the graft can be difficult to manage, and late problems (e.g., aneurysms of the arterial buttons, periaortic fistulas) can occur 18,19 . On the other hand, when considering rates of aortic root reoperation or root dissection in patients undergoing selective NCS replacement, the risk of these complications is extremely rare (as shown in this paper and as previously reported by other groups 20–22 ).…”

Section: Discussionsupporting

confidence: 83%

Residual root fate after aortic surgery in bicuspid aortic valve with right‐to‐left fusion: A comparative risk analysis

Pradegan

Azzolina

Gregori

et al. 2021

Journal of Cardiac Surgery

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Background and Aim Although bicuspid aortic valve (BAV) anatomy might influence aortic aneurysm development, BAV‐related root involvement still lacks standardized surgical management. We aimed to evaluate late clinical outcomes and risk factors for root dilation after proximal aortic replacement in patients with BAV and right–left fusion (RL‐BAV). Methods Clinical and echocardiographic data of all patients with intraoperative RL‐BAV who underwent ascending aortic replacement with or without noncoronary sinus (NCS) replacement (Groups 1 and 2, respectively) between 1999 and 2017, were retrospectively revised. A multivariable analysis assessed hazard factors for root dilation during follow‐up (FU). Results Of 206 surgeries performed (M 81%; age: 57 ± 13 years, EuroSCORE II: 2.7 ± 1.9%), 79 (38%) required NCS replacement. One hundred fifty‐seven patients (76%) underwent aortic valve replacement (with aortic regurgitation predominating in Group 1, p = .04). The preoperative aortic root was larger in patients requiring NCS replacement (43.3 ± 5.1 vs. 39.2 ± 4.8 mm, p < .001). At a median FU time of 7 years (interquartile range: 4–10), no residual root dissections occurred, and only two patients (belonging to Group 2) required redo root surgery. Preoperative mild aortic regurgitation and aortic root diameter >35 mm at discharge were risk factors for root dilation >40 mm at FU (p = .02). Aortic root did not dilate over time, irrespective of NCS replacement (p = .06). Conclusions Aortic root in patients with RL‐BAV undergoing ascending aortic replacement (±NCS replacement) does not significantly dilate over time, even if patients with preoperative aortic regurgitation and postoperative root more than 35 mm might require more surveillance.

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Section: Discussionsupporting

confidence: 83%

Residual root fate after aortic surgery in bicuspid aortic valve with right‐to‐left fusion: A comparative risk analysis

Pradegan

Azzolina

Gregori

et al. 2021

Journal of Cardiac Surgery

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“…Numerous studies proposed a revised Bentall procedure [8][9][10][11][12], but all those techniques include reimplantation of the coronary ostia which is the "Achille's heel" of this procedure. Aortic valvular repair was proposed by David et al but had the same limitations about the coronary ostia reimplantation [13][14][15]. The aortic plasties described in the literature are completely different.…”

Section: Discussionmentioning

confidence: 99%

“…The continuous rolling suture is adapted to this technique to secure the valve with a simultaneous reduction of the Valsalva tissue. Secondary aneurysm of the coronary ostia known after Bentall procedure is due to the suture itself and to the remaining tissue [7,[12][13][14][15]. When the « reduction plasty » of the sinuses of Valsalva is performed the remaining tissue is heavy, strong and secured, without the coronary ostium manipulation which can involve falses aneurysms or ostium twist leading to a secondary ischemia.…”

Section: Discussionmentioning

confidence: 99%

The Remadi’s technique or the Bentall Technic? Valsalvas Reduction Plasty

JP,

2023

J Cardiol Clin Res

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The objective of this study was to find an another surgical way than Bentall procedure to treat the aneurysms of ascending aorta involving the sinuses of valsalvas. From September 2008 to May 2018, eighty five patients underwent aortic valve replacement (AVR) associated with a Valsalva plasty, with or without the replacement of the ascending aorta. All the procedures were performed by a single surgeon (Remadi’s technique) at Amiens Universitary Hospital in France. There was no operative death. During the follow-up at ten years, the diameters of the Sinuses of Valsalva remain steady, without long term post-operative aneurysm or reoperation for any aortic complication. This original new technic, can be applied safety for almost all ascending aorta aneurysms involving valsalvas (more than 90% of cases) instead of the bentall procedure. This new technic is safe with excellent immediate and mid- term results. The Remadi’s technic is particularly adapted for the older patients or patients with associated comorbidity in order to reduce the operative risk. The Bentall’technic should be performed only when the ascending aorta has a shape like a « chianti bottle with very important dilatation of sinuses of valsalvas, when its the only procedure adapted for those remaining indications.

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“…We did not use the Cabrol technique because it may lead to the formation of blood clots in coronary artery grafts 22 . Most surgeons tend to use mechanical valves for aortic root replacement surgery to avoid reoperation, but the risk of reoperation must be weighed against the risk of stroke and bleeding.In some studies [23][24] , 57% of patients underwent bioprosthetic valve replacement, and this part of patients was more free from thromboembolic complications after 10 years.In this group of data, 2 patients had stroke during hospitalization, and 2 patients died of cerebral hemorrhage during follow-up, which may be closely related to oral anticoagulants. In elderly patients, a new generation of biological valves may be safer, because biological valve failure is relatively rare in this age group 25 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Redo Aortic Root Replacement after Cardiac Surgery

Deng¹,

Zhong²

2021

ijmsci

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[Abstract] objectives To explore the etologies, surgical methods and outcomes of redo aortic root replacement after cardiac surgery. Methods Between February 2010 and February 2020, 41 patients who had at least one previous cardiac operation received aortic root replacement surgery in our hospita, including 27 males and 14 females with an average age of 49.5±10.2 years. Indications for reoperation include: aortic sinus dilation and ascending aortic aneurysm in 20 cases (48.8%), recurrent aortic dissection in 7 cases (17.0%), aortic pseudoaneurysm in 4 cases (9.8%), prosthetic valve endocarditis in 5 cases (12.2%) and 5 cases (12.2%) had paravalvular leakage. The redo operation was a midline thoracotomy, and Bentall operation was performed. In addition, 3 cases of mitral valve replacement surgery, 4 cases of mitral valvuloplasty, 8 cases of tricuspid valvuloplasty, 4 cases of coronary artery bypass graft surgery, 3 cases of Debakey I aortic dissection patients underwent Sun’s surgery simultaneously. Results The mean cardiopulmonary bypass time was 95~302 (168.1±41.2) min, and the mean aortic crossclamp time was 45~135 (84.5±22.3) min. Six patients (14.6%) died during the postoperative hospitalization. The main causes of death were heart failure in 3 patients and septic shock in 3 patients.The follow-up time was 3~62 (30.3±15.5) months. During the follow-up period, 3 cases died, including 1 case died of septic shock and 2 cases died of cerebral hemorrhage. Conclusions Redo aortic root replacement is difficult to deal with, and the risk is high. Preoperative evaluation is required, appropriate surgical approach, adequate myocardial protection, and a complete surgical plan are essential to ensure the success of the operation.

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Comparison of Three Different Surgical Methods in Aortic Root Aneurysms: Long‐Term Results

Abstract: Noncoronary cusp replacement for aortic root remodeling in patients with ascending aortic aneurysm is a technically simple and durable operation. Short- and mid-term results of this method were favorable compared to the Bentall procedure.

Cited by 6 publications

References 13 publications

Residual root fate after aortic surgery in bicuspid aortic valve with right‐to‐left fusion: A comparative risk analysis

Residual root fate after aortic surgery in bicuspid aortic valve with right‐to‐left fusion: A comparative risk analysis

The Remadi’s technique or the Bentall Technic? Valsalvas Reduction Plasty

Clinical Analysis of Redo Aortic Root Replacement after Cardiac Surgery

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