Mid-term results after sinutubular junction remodelling with aortic cusp repair

Asano, Masaharu; Kunihara, Takashi; Aicher, Diana; Beyrouti, Hazem El; Rodionycheva, Svetlana; Schäfers, Hans‐Joachim

doi:10.1093/ejcts/ezs120

Cited by 30 publications

(20 citation statements)

References 19 publications

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“…Heterogeneity among studies was significant (I 2 =56%; P =0.003). However, after excluding the study by Asano et al., all results were confirmed without heterogeneity (OR, 0.49; 95% CI: 0.39, 0.61; P <0.001; I 2 =37%; P =0.07).…”

Section: Resultsmentioning

confidence: 80%

“…by means of an unadjusted analysis. On the other hand, it is noteworthy to stress that 4 studies consistently highlighted that an increasing age was the main predictor of postoperative mortality. Overall, these evidences confirm and extend our data suggesting that the difference in mean age between BAV and TAV might, at least in part, explain the difference in postoperative mortality documented in these 2 groups.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Valve Morphology on the Prevalence of Coronary Artery Disease: A Systematic Review and Meta‐Analysis

Poggio

Cavallotti

Songia

et al. 2016

JAHA

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BackgroundLiterature studies suggested a lower prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) than in tricuspid aortic valve (TAV) patients. However, this finding has been challenged. We performed a meta‐analysis to assess whether aortic valve morphology has a different association with CAD, concomitant coronary artery bypass grafting (CABG), and postoperative mortality.Methods and ResultsDetailed search was conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐Analyses) guideline to identify all patients with BAV or TAV and presence of CAD, concomitant myocardial surgical revascularization, and the postoperative mortality. Thirty‐one studies on 3017 BAV and 4586 TAV patients undergoing aortic valve surgery were included. BAV patients showed a lower prevalence of CAD (odds ratio [OR]: 0.33; 95% CI: 0.17, 0.65), concomitant CABG (OR, 0.45; 95% CI: 0.35, 0.59), and postoperative mortality (OR, 0.62; 95% CI: 0.40, 0.97) than TAV. However, BAV subjects were significantly younger than TAV (mean difference: −7.29; 95% CI: −11.17, −3.41) were more frequently males (OR, 1.61; 95% CI: 1.33, 1.94) and exhibited a lower prevalence of hypertension (OR, 0.58; 95% CI: 0.39, 0.87) and diabetes (OR, 0.71; 95% CI: 0.54, 0.93). Interestingly, a metaregression analysis showed that younger age and lower prevalence of diabetes were associated with lower prevalence of CAD (Z value: −3.03; P=0.002 and Z value: −3.10; P=0.002, respectively) and CABG (Z value: −2.69; P=0.007 and Z value: −3.36; P=0.001, respectively) documented in BAV patients.ConclusionsAnalysis of raw data suggested an association of aortic valve morphology with prevalence of CAD, concomitant CABG, and postoperative mortality. Interestingly, the differences in age and diabetes have a profound impact on prevalence of CAD between BAV and TAV. In conclusion, our meta‐analysis suggests that the presence of CAD is independent of aortic valve morphology.

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Section: Resultsmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Impact of Valve Morphology on the Prevalence of Coronary Artery Disease: A Systematic Review and Meta‐Analysis

Poggio

Cavallotti

Songia

et al. 2016

JAHA

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“…Older patients (e.g., age >50 years) with ascending aortic aneurysm and dilated sinotubular junction with normal cusps and normal aortic annulus and moderate or severe AI can have simple replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to allow the cusps to coapt centrally [ 17 , 18 ]. This type of remodeling of the aortic root is illustrated in Fig.…”

Section: Operative Techniquesmentioning

confidence: 99%

Aortic Valve Sparing Operations: A Review

David

2012

Korean J Thorac Cardiovasc Surg

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Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.

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“…Experience has shown that the incidence and degree of cusp prolapse correlates with the preoperative degree of regurgitation. 5 Alternatively, the surgeon becomes familiar with more objective means of assessing cusp configuration, such as determination of effective height 6 in order to correct cusp prolapse reproducibly. He also has to keep in mind that cusp stretching may be masked by dilatation of the root and will become apparent after normalizing root dimensions, that is, intercommissural distance.…”

Section: Introductionmentioning

confidence: 99%

Aortic Root Remodeling

Schneider

Schäfers

2018

Operative Techniques in Thoracic and Cardiovascular Surgery

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Valve-preserving aortic root replacement has become an attractive alternative to composite replacement leading to better quality of life and minimal valve-related complications. Root remodeling requires less surgical dissection and has been shown to lead to more physiological hemodynamics compared to valve reimplantation. Over the last 2 decades, improvements have been made regarding assessment of cusp and root configuration. Aggressive correction of cusp prolapse extended the application of root remodeling to a larger patient population and has markedly improved valve stability, even in patients with connective tissue disorders. In the presence of annular dilatation, the addition of an annuloplasty has been shown to be beneficial for valve competence and repair durability. Aortic root remodeling combined with cusp repair and correction of annular dilatation leads to excellent valve stability and minimal valve-related complications. Operative Techniques in Thoracic and Cardiovasculary Surgery 23:102À120

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Mid-term results after sinutubular junction remodelling with aortic cusp repair

Cited by 30 publications

References 19 publications

Impact of Valve Morphology on the Prevalence of Coronary Artery Disease: A Systematic Review and Meta‐Analysis

Impact of Valve Morphology on the Prevalence of Coronary Artery Disease: A Systematic Review and Meta‐Analysis

Aortic Valve Sparing Operations: A Review

Aortic Root Remodeling

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