Long-Term Results of Neomedia Sinus Valsalva Repair in 489 Patients With Type A Aortic Dissection

Rylski, Bartosz; Bavaria, Joseph E.; Milewski, Rita K.; Vallabhajosyula, Prashanth; Moser, William; Kremens, Emily; Pochettino, Alberto; Szeto, Wilson Y.; Desai, Nimesh D.

doi:10.1016/j.athoracsur.2014.04.050

Cited by 93 publications

(81 citation statements)

References 15 publications

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“…Multiple root repair techniques using prosthetic and biologic materials have been reported (4)(5)(6)(7)(8)(9). The two most commonly described methods involve fortification of the aortic wall using Teflon felt and/or biologic glue.…”

Section: Aortic Root Repairmentioning

confidence: 99%

When and how to replace the aortic root in type A aortic dissection

Leshnower

Chen

2016

Ann. Cardiothorac. Surg.

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Management of aortic root pathology during repair of acute type A aortic dissection (TAAD) requires a comprehensive evaluation of the patient's anatomy, demographics, comorbidities and physiologic status at the time of emergent operative intervention. Surgical options include conservative repair of the root (CRR) (with or without replacement of the aortic valve), replacement of the native valve and aortic root using a composite valve-conduit and valve sparing root replacement (VSRR). The primary objective of this review is to provide data for surgeons to aid in their decision-making process regarding management of the aortic root during repair of TAAD. No time or language restrictions were imposed and references of the selected studies were checked for additional relevant citations. Multiple retrospective reviews have demonstrated equivalent operative mortality between aortic root repair and replacement during TAAD. There is a higher incidence of aortic root reintervention with aortic root repair compared to aortic root replacement (ARR). Experienced, high-volume aortic centers have demonstrated the safety of VSRR in young, hemodynamically stable patients presenting with TAAD. In conclusion, aortic root repair can safely be performed in the vast majority of patients with TAAD. Despite the increased surgical complexity, ARR does not increase operative mortality and improves the freedom from root reintervention. VSRR can be performed in highly selected populations of patients with TAAD with durable mid-term valve function.

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Section: Aortic Root Repairmentioning

confidence: 99%

When and how to replace the aortic root in type A aortic dissection

Leshnower

Chen

2016

Ann. Cardiothorac. Surg.

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“…The valve is frequently normal in patients with AcA-AoD and thus potentially salvageable in spite of an extensively dissected aortic root and the presence of aortic regurgitation (48,60). V-SARR, pioneered by David et al (87,88) and Sir Yacoub et al (89), has been shown to have satisfactory 15-year results in a variety of settings, including patients with connective tissue disorders and bicuspid aortopathy, in the proper experienced hands (90)(91)(92)(93)(94).…”

Section: Replacement Of the Valve And Rootmentioning

confidence: 99%

“…The simplicity of the technique, which did not require substantial alteration of cannulation strategy, allowed for rapid setup in both elective and emergency situations (60,123,124). The presence of a competent internal jugular vein valve and extensive venovenous shunting, however, severely limit the effectiveness of this technique, as only a fraction of the blood delivered into the superior vena cava for RCP actually reaches the brain (125,126).…”

Section: The Arch Cerebral Protection and Cannulation Strategymentioning

confidence: 99%

“…This trial was-in some respects-handicapped by the short period of circulatory arrest (27±13 minutes), such that the magnitude of the cerebral insult was likely not great enough to discern any difference between brain protection methods (129). Reflecting the importance of time, the practice at the University of Pennsylvania has been to use RCP in general but to use bilateral antegrade perfusion in cases necessitating greater than 40 minutes of circulatory arrest (60).…”

Section: The Arch Cerebral Protection and Cannulation Strategymentioning

confidence: 99%

“…Early in the experience at Stanford, Teflon felt was used to fill the false lumen and reinforce the aorta externally (41,48). Although Teflon felt is only very rarely used today at Stanford for any thoracic aortic procedure (instead we rely on fine suture with a small needle to reconstruct the dissected layers), this technique is used commonly elsewhere to avoid CVG replacement (44,60,61). In Europe during the 1980s and 1990s, gelatin-resorcinolformaldehyde (GRF) "French" glue was popular for reconstructing the friable Sinus of Valsalva tissue.…”

Section: Replacement Of the Valve And Rootmentioning

confidence: 99%

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Evolution of surgical therapy for Stanford acute type A aortic dissection

Chiu

Miller

2016

Ann. Cardiothorac. Surg.

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Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small?The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.

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Management of Complicated Acute Type A Aortic Dissection: The Stanford Approach

Pedroza

Fischbein

2021

Aortic Dissection and Acute Aortic Syndromes

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Long-Term Results of Neomedia Sinus Valsalva Repair in 489 Patients With Type A Aortic Dissection

Cited by 93 publications

References 15 publications

When and how to replace the aortic root in type A aortic dissection

When and how to replace the aortic root in type A aortic dissection

Evolution of surgical therapy for Stanford acute type A aortic dissection

Management of Complicated Acute Type A Aortic Dissection: The Stanford Approach

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