Patient selection for aortic valve-sparing operations

Jahanyar, Jama; Kerchove, Laurent de; Tsai, Peter I.; Mastrobuoni, Stefano; Arabkhani, Bardia; Aphram, Gaby; Khoury, Gébrine El

doi:10.21037/acs-2023-avs1-19

Cited by 4 publications

(10 citation statements)

References 10 publications

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“…Several expert groups report their experience over decades. [51][52][53] They all describe excellent long-term outcomes for valve repair/reimplantation associated with low rates of re-intervention and valve-related complications (VRCs). The only replacement option demonstrating similar long-term outcomes with low rates of re-intervention and VRC appears to be the Ross procedure (in dedicated centers with high expertise).…”

Section: Conventional Aortic Valve Surgerymentioning

confidence: 99%

Cardiac Surgery 2023 Reviewed

Kirov,

Caldonazo,

Mukharyamov

et al. 2024

Thorac Cardiovasc Surg

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We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term “cardiac surgery AND 2023.” We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.

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Section: Conventional Aortic Valve Surgerymentioning

confidence: 99%

Cardiac Surgery 2023 Reviewed

Kirov,

Caldonazo,

Mukharyamov

et al. 2024

Thorac Cardiovasc Surg

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“…The VAJ, however, is not a consistent landmark. It varies by valve phenotype (e.g., bicuspid vs. tricuspid aortic valve) and area of the aortic root (anterior versus posterior) (2,4). Posteriorly, the VAJ is equal to the VBR (a virtual line drawn to connect the nadirs of semilunar leaflet insertions) as they overlap, but anteriorly, there is variation of the VAJ, which then leads to varying areas of the ventricular wall becoming part of the aortic sinuses of Valsalva.…”

Section: Aortic Annulus and Aortic Root Ventriculo-aortic Transitionmentioning

confidence: 99%

“…It's simply the transition point where the left ventricular muscular and fibrous tissue is replaced by the fibroelastic walls of the aortic valve sinuses (8,9). Hence, in lieu of the VAJ we use the VBR as a surgical landmark, which is also commonly referred to as the aortic annulus (8,10), surgical annulus (2) or echocardiographic annulus (11). Therefore, this represents an important landmark during surgical procedures, surgical planning and diagnostic imaging (e.g., TAVR sizing).…”

Section: Aortic Annulus and Aortic Root Ventriculo-aortic Transitionmentioning

confidence: 99%

“…As our understanding of the aortic valve improved, however, it became increasingly evident that the entire aortic root from VBR to sinotubular junction (STJ) represents the necessary support scaffold for the aortic valve (Figure 2). Thus, for proper aortic valve function, a healthy relationship between valve leaflets (free margin length and geometric height) and FAA dimensions (VBR, sinus of Valsalva and STJ) is crucial (2,12).…”

Section: The Faamentioning

confidence: 99%

“…We have recently described the aortic root anatomy in detail, as it pertains to aortic valve repair and/or valvesparing aortic root replacement (2). Thus, herein we will focus more on the aortic root anatomy, as it pertains to aortic valve replacement and annular and LVOT enlargements, where no further emphasis is placed on the function and anatomy of the aortic valve leaflets, as they are excised during the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Aortic root anatomy: insights into annular and root enlargement techniques

Jahanyar,

Said,

Kerchove

et al. 2024

Ann Cardiothorac Surg

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The introduction of the Y(ang)-technique for aortic root enlargement has sparked a renewed interest in annular and root enlargement procedures world-wide. In order to execute these procedures proficiently however, it's important to understand the complex three-dimensional structure of the aortic root and left ventricular outflow tract, and also be familiar with the different enlargement techniques. Herein, we are providing a description of the aortic root anatomy and the most commonly utilized root enlargement procedures. This should facilitate clinical decision making and guidance of patients towards the most appropriate procedure, which should not only treat the patients' acute symptoms, but should also set the patient up for potentially needed future procedures and respective life-time management of aortic valve disease.

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