Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation

Pessotto, Renzo; Santini, Francesco; Pugliese, Peppino; Montalbano, Giuseppe; Luciani, Giovanni Battista; Faggian, Giuseppe; Bertolini, Paolo; Mazzucco, Alessandro

doi:10.1016/s0003-4975(99)00417-8

Cited by 54 publications

(37 citation statements)

References 11 publications

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“…In fact a complete replacement of the ascending aorta and aortic root at the time of acute presentation completely prevents this type of complication. Other authors suggest replacing the aortic root whenever in the presence of a preoperative moderate-to-severe AR since they noted a higher incidence of early reoperation in this subgroup of patients [12].…”

Section: Discussionmentioning

confidence: 98%

Effects of ascending aorta replacement on aortic root dilatation

Paulis¹,

Cetrano²,

Moscarelli³

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 98%

Effects of ascending aorta replacement on aortic root dilatation

Paulis¹,

Cetrano²,

Moscarelli³

et al. 2005

European Journal of Cardio-Thoracic Surgery

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“…If there is aortic valve insufficiency without sinus dilation, aortic valve replacement can be performed, which is followed by ascending aortic replacement, known as Wheat operation. For patients with sinus dilation and normal aortic valve function or slight regurgitation, valve-sparing root replacement, known as David operation, might be an option, which can avoid cerebral stroke, latent false lumen rupture or recurrence of dissection resulting from lifetime-anticoagulation [8] . For the patients with severe aortic root damage with a sinus diameter exceeding 5 cm, rupture of aortic valve commissure and massive regurgitation of aorta, aortic root replacements such as Bentall operation or Carbrol operation should be employed.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of aortic aneurysm and aortic dissection: A retrospective analysis of 122 cases

Sun

Jiang

Zhang

et al. 2009

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement (n=3), aortic root replacement (n=43), hemi-arch replacement /total arch replacement+elephant trunk technique (n=32), thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36). In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1), respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2). Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.

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“…However, supracommissural replacement leaves diseased aortic tissue in place carrying an increased risk of late reintervention for progressive root dilatation, redissection of repaired sinus or valve failure [14][15][16][17][18][19].…”

Section: Repair Of the Aortic Rootmentioning

confidence: 99%

“…Freedom from proximal intervention ranges between 95 ± 2 % to 100 % at 1 year and 85 to 89 ± 4 % at 5 years [16,18,19]. It has also been reported that up to 20 % of patients who received a commissural resuspension and obliteration of the proximal false lumen reinforced with Teflon felt required aortic root replacement 10 years postoperatively [14,15].…”

Section: Repair Of the Aortic Rootmentioning

confidence: 99%

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Emergency valve-sparing operations for acute aortic dissection

Essawi

Harringer

2004

Eur Surg

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Klappenerhaltende Operationstechniken bei der akuten AortendissektionZusammenfassung. Grundlagen: Klappenerhaltende Verfahren bei Patienten mit akuter Dissektion der Aorta ascendens sind bei makroskopisch intakten Taschenklappen möglich. Die Reinterventionsrate an der Aortenwurzel 10 Jahre nach suprakommisuralem Ersatz beträgt bis zu 20 %.Methodik: Durchsicht der Literatur. Ergebnisse: Im Falle einer ausgeprägten Dissektion der Wurzel, annuloaortaler Ektasie oder bei bestehender Bindegewebserkrankung wie dem Marfan-Syndrom erscheint eine radikalere Taktik ratsam. Unter den verfügba-ren Verfahren zeigte sich, dass die Remodeling-Technik besser geeignet ist die Flexibilität und daher die Physiologie der Aortenwurzel zu erhalten. Der vorteilhafte Einfluss dieser erhaltenen Physiologie auf die Lebenserwartung der rekonstruierten Klappe bleibt allerdings unbestä-tigt. Andererseits besteht durch die radikalere Entfernung von erkranktem Gewebe an der Aortenwurzel sowie durch die zusätzliche Stabilisierung des Annulus bei der Reimplantations-Technik eine niedrige proximale Reinterventionsrate.Schlussfolgerungen: Diese Ergebnisse sowie die bessere Hämostase bei dem vulnerablen dissezierten Gewebe, machen die Reimplantationstechnik in unsere Meinung zum besten klappenerhaltenden Verfahren.Schlüsselwörter: Aortendissektion, Klappenerhaltende Operationstechniken, Aortenklappe.Summary. Background: Valve-sparing procedures in AADA are feasible whenever valve cusps appear macroscopically intact. Secondary root interventions amount to 20 % at 10 years following root repair with supracommissural replacement.Methods: Review of literature.Results: In case of extensive root dissection, annuloaortic ectasia or presence of a connective tissue disorder like Marfan's syndrome, a more aggressive approach appears advisable. Although the remodeling technique has been proven to preserve more of the flexibility and thus physiology of the aortic root, the impact of this advantage on the durability of valve repair is still missing. On the contrary, as the reimplantation technique is more radical in terms of exclusion of all diseased tissue and adds complete stabilization of the aortic annulus the need for proximal reoperations has been low.Conclusions: These results, and the better hemostasis in these friable dissected tissues, make the reimplantation technique in our opinion the best suited valve sparing technique.

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Preservation of the aortic valve in acute type A dissection complicated by aortic regurgitation

Cited by 54 publications

References 11 publications

Effects of ascending aorta replacement on aortic root dilatation

Effects of ascending aorta replacement on aortic root dilatation

Surgical treatment of aortic aneurysm and aortic dissection: A retrospective analysis of 122 cases

Emergency valve-sparing operations for acute aortic dissection

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