Composite Valve Graft versus Separate Aortic Valve and Ascending Aortic Replacement

Abstract

To ascertain if the operative technique has any influence on outcome, the surgical results after aortic root replacement using either a composite valve graft (CVG) or a separate graft and valve (SVG) were analyzed. Eighty-four patients received a CVG, and 36 had SVG replacement. The operative mortality rate was 6% for patients receiving a CVG and 3% for SVG replacement (nonsignificant). Follow-up extended to 21 years (mean 124 ± 45 months). The type of the procedure (SVG versus CVG) was not a significant predictor of in-hospital mortality, length of hospital stay, subsequent root dilatation (SVG), anastomotic dehiscence and subsequent surgery. The early and long-term results after CVG or SVG were similar, which reflects proper patient selection.

Bentall Procedure: A Systematic Review and Meta-Analysis

“…Mean follow-up after the Bentall procedure was 6.4 years (range, 3.0-10.4 years), resulting in a total of 49,175 patient-years. From 4 articles, it proved impossible to ascertain the exact number of late deaths [8,20,36,45]. Although unknown or unreported in 47.9% of cases, the main causes of late mortality were low cardiac output (9.9%), distal aortic dissection or rupture (8.9%), hemorrhage (4.1%), stroke (3.8%), endocarditis (3.7%), cardiac arrhythmias (3.3%), other cardiac-related deaths (9.6%) and other non-cardiac-related deaths (8.9%).…”

Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study

“… 2 Aortic valve operation and ascending aorta replacement (AV–AA) typically involves hypothermia, prolonged cardiopulmonary bypass (CPB), and large graft anastomoses, and is associated with an increased risk of intra- and postoperative blood loss and high transfusion rates. 3 4 Conventional haemostatic therapy consists of transfusion of allogeneic blood products that include fresh-frozen plasma (FFP), platelet concentrate, and cryoprecipitate. However, although the use of these products was developed empirically, their haemostatic efficacy has not been evaluated thoroughly in the surgical setting.…”

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

“…In another hand, when a biological Bentall failed, the redo procedure is more difficult than an isolated redo AVR, therefore the results are worse. 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].…”