Midterm Results of David V Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection

Leshnower, Bradley G.; Myung, Richard J.; McPherson, LaRonica; Chen, Edward P.

doi:10.1016/j.athoracsur.2014.08.079

Cited by 75 publications

(54 citation statements)

References 21 publications

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“…The existing data regarding performance of VSRR in TAAD is limited and has been reported by high volume aortic centers with significant experience with VSRR in the elective setting (19)(20)(21)(22)(23). These reports demonstrate durable valve function and no increase in operative mortality in relatively small cohorts of patients, thus reflecting the importance of careful patient selection.…”

Section: Aortic Root Replacement (Arr)mentioning

confidence: 93%

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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 Replacement (Arr)mentioning

confidence: 93%

“…There were no aortic root reinterventions and eight (19%) distal aortic reinterventions in this series. These patients continue to be followed closely with annual surveillance echocardiograms and cross sectional imaging to monitor valve durability and the size of the residually dissected aorta (21).…”

Section: Aortic Root Replacement (Arr)mentioning

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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“…Once the decision was made to proceed with VSRR, reimplantation with David V method was performed, as previously described [11,12]. The majority of graft prostheses were tailored straight tube grafts; however, the Gelweave Valsalva (Vascutek; Terumo, Ann Arbor, MI) and the Cardioroot (Maquet, Wayne, NJ) grafts were occasionally used.…”

Section: Surgical Techniquementioning

confidence: 99%

“…The Emory technique of the David V VSRR and arch replacement has been described previously [11,12]. Patients undergoing isolated aortic root replacement received central aortic and right atrial cannulation.…”

Section: Surgical Techniquementioning

confidence: 99%

The David V Valve-Sparing Root Replacement Provides Improved Survival Compared With Mechanical Valve-conduits in the Treatment of Young Patients With Aortic Root Pathology

Esaki

Leshnower

Binongo

et al. 2016

The Annals of Thoracic Surgery

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“…This conservative attitude towards the valve per se can be continued, even if root replacement is necessary. Tirone David re-implantation valve-sparing aortic root replacement (V-SARR) in carefully selected, younger AcA-AoD patients who are not moribund has been reported with acceptable mid-term results from Hannover, Germany and by Chen's group at Emory (50,51). If the valve cannot be conserved in a durable manner due to abnormal cusp pathology or dissection trauma, it should be replaced.…”

Section: Replacement Of the Valve And Rootmentioning

confidence: 99%

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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Midterm Results of David V Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection

Cited by 75 publications

References 21 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

The David V Valve-Sparing Root Replacement Provides Improved Survival Compared With Mechanical Valve-conduits in the Treatment of Young Patients With Aortic Root Pathology

Evolution of surgical therapy for Stanford acute type A aortic dissection

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