Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation

Mastrobuoni, Stefano; Kerchove, Laurent de; Navarra, Emiliano; Watremez, Christine; Vancraeynest, David; Rubay, Jean; Noirhomme, Philippe; Khoury, Gébrine El

doi:10.1016/j.jtcvs.2018.10.155

Cited by 74 publications

(68 citation statements)

References 29 publications

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“…Their results demonstrated that independent of the status of the root and degree of aortic valve disease, VSRR could be performed safely and with excellent long-term durability. 3 These results attest to the beauty of the VSRR, or the David procedure, and merit publication both for dissemination of the results as well as a tribute to the work of the El Khoury group and the vision of David and Feindel. 4 Of interest are the 76 patients in the third, nonconventional group.…”

mentioning

confidence: 76%

“…In this study from the Belgium group led by El Khoury, the results from 440 valve-sparing root replacements (VSRRs) were reviewed. 3 The group was subdivided into 3 cohorts related to the traditional indications for VSRR: conventional for treatment of root aneurysms without aortic valve disease, debated for root aneurysms with aortic valve disease, and nonconventional for aortic valve disease when a root aneurysm is not involved. Their results demonstrated that independent of the status of the root and degree of aortic valve disease, VSRR could be performed safely and with excellent long-term durability.…”

mentioning

confidence: 99%

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Commentary: Valve-sparing reimplantation: Is support the key to aortic valve repair?

Levy

Rajagopal²,

DeAnda

2019

The Journal of Thoracic and Cardiovascular Surgery

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confidence: 76%

mentioning

confidence: 99%

Commentary: Valve-sparing reimplantation: Is support the key to aortic valve repair?

Levy

Rajagopal²,

DeAnda

2019

The Journal of Thoracic and Cardiovascular Surgery

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“…In this cohort, the early mortality was 1.2% and the overall survival at 10 and 15 years was 89.5 ± 2.0% and 77.9 ± 3.9%, respectively. In a recent study, Mastrobuoni et al [5] reported the long-term experience in 440 consecutive patients (mean age, 49 years; mean follow-up of five years; completeness of follow-up was 78%.) with aortic root aneurysm undergoing the reimplantation technique and a high number of associated ACR procedures (72.7%).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a high percentage of the patients (83.9%) for type II AR dysfuntion underwent free-margin central plication as the most simple, reproducible, and efficient technique in case of cusp prolapse repair [3, 5].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes and predictors of recurrent aortic regurgitation after aortic valve-sparing and reconstructive cusp surgery: a single centre experience

Karčiauskas

Mizarienė

Jakuška

et al. 2019

J Cardiothorac Surg

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BackgroundAortic valve sparing surgery (AVS), in combination with aortic cusp repair (ACR), still raises many questions about the increased surgical complexity and applicability for patients with pure aortic valve regurgitation (AR). The aim of this study was to investigate our long-term outcomes and predictors of recurrent AR (> 2+) after AVS and reconstructive cusp surgery.MethodsWe reviewed data of 81 patients who underwent AVS (a reimplantation technique) with concomitant ACR for AR and or dilatation of the aortic root at our institution during the period from April 2004 to October 2016. On preoperative echocardiography, the majority of the patients, 70 (86.4%) presented with severe AR grade (> 3+) and 28 (34.5%) of the patients had the bicuspid phenotype. Time to event analysis (long-term survival, freedom from reoperation, and recurrence of AR > 2+) was performed with the Kaplan–Meier method. Multivariate Cox regression risk analysis was performed to identify independent predictors of recurrent AR (> 2+). The mean follow-up was 5.3 ± 3.3 years and 100% complete.ResultsThe in-hospital (30-day) mortality rate after elective surgery was 1.2%. The overall actuarial survival rates were 92.9 ± 3.1% and 90.4 ± 3.9% at five and 10 years, respectively. Actuarial freedom from recurrent AR (> 2+) was 83.7 ± 4.5% within the cohort at five and 10 years. The cumulative freedom from all causes of cardiac reoperation was 94.2 ± 2.8% within the cohort at 10 years. Neither bleeding nor thromboembolic or permanent neurologic events were reported during follow-up. By multivariate analysis, independent predictors of reccurent AR (> 2+) were an effective height lower than 9 mm (p= 0.02) and intraoperative residual mild AR (p= 0.0001).ConclusionsAVS with ACR, combined in a systematic fashion, is a safe and reproducible option with low risk of long-term valve related events and normal life expectancy for patients with pure aortic regurgitation.The competent aortic valve and effective height, not lower than 9 mm intraoperatively, are mandatory to achieve long-lasting AV competency.

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“…11 Similar results have been reported by Lansac's and El Khoury's groups for bicuspid and tricuspid valves. 12,13 VSRR is a very promising technique, and it is becoming more and more standardized. Its systematic application in the case of aortic root aneurysm with a reparable valve represents the ideal solution, especially for young patients with long life expectancy.…”

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confidence: 99%

Commentary: Valve sparing in aortic root aneurysms—An old promise or a concrete chance?

Bacco

Glauber

Miceli

2019

The Journal of Thoracic and Cardiovascular Surgery

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The restoration of the normal dimension and geometry of aortic root, in particular in patients with genetic collagen disorders, improves survival and reduce incidence of adverse aorta-related events. 1 For many years, the standard treatment for patients with aortic root aneurysm consisted in aortic root replacement with composite mechanical valve conduit and coronary reimplantation. 2 Inspired by the mitral experience, reconstructive methods of sparing the aortic valve, associated with replacement of the other component of the aortic root, have been developed with the aim of reducing the risk of thromboembolic and endocarditis events while restoring the normal life expectancy and quality of the life. 3 In this issue of the Journal, Kunihara and colleagues 4 report Japanese Cardiovascular Database outcomes of more than 5000 patients undergoing aortic root replacement with valve-sparing root replacement (VSRR) techniques or composite graft-valve (CGV) procedures with mechanical or biological prostheses. Even though VSRR procedures (remodeling and reimplantation techniques) had longer cardiopulmonary bypass and crossclamp times, Kunihara and colleagues 4 concluded that aortic valve-sparing root replacement was associated with lower morbidity and mortality than CGV. Specifically, the CGV group had a significantly higher incidence of postoperative stroke and prolonged ventilation (>72 hours). Finally, in-hospital mortality was significantly higher in the CGV group than in the VSRR group. 4 This article by Kunihara and colleagues 4 offers an important contribution regarding the dilemma of whether replacing the aortic valve is better than sparing it when aortic root replacement is required. With a large sample size, after matching, Kunihara and colleagues 4 confirm data that VSRR can reduce valve-related complications. Avoiding lifelong oral anticoagulation, valve-sparing procedures reduce the hemorrhagic or thromboembolic adverse events seen with mechanical CGV. Moreover, VRSS may reduce valve dysfunction and reoperation rate relative to bioprostheses. 4 The intuitive message that preservation of the native valve is better than replacement has been consistently supported by David and colleagues. 5 As Kunihara and colleagues 4 state, in most cases, aortic valve cusps are normal or stretched from annuloaortoectasia, and the valve can recover its normal function once normal root geometry has been restored.Concerns remain about valve-sparing surgery, however, with regard to indications, reproducibility, success rate, and duration. Since David and Yacoub developed the reimplantation and remodeling techniques, 6,7 VSRR procedures gained great popularity but never reached a widespread diffusion, with operations on the aortic root not exceeding 15% of surgical procedures. 8 These strategies actually remain technically demanding and require a deep knowledge of aortic root and valve geometry, anatomy, and dynamics. 9 Unsatisfactory VSRR could lead to an early failure. The most common pitfalls are represented by incorrect graft s...

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Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation

Cited by 74 publications

References 29 publications

Commentary: Valve-sparing reimplantation: Is support the key to aortic valve repair?

Commentary: Valve-sparing reimplantation: Is support the key to aortic valve repair?

Long-term outcomes and predictors of recurrent aortic regurgitation after aortic valve-sparing and reconstructive cusp surgery: a single centre experience

Commentary: Valve sparing in aortic root aneurysms—An old promise or a concrete chance?

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