The aortic root does not dilate over time after replacement of the aortic valve and ascending aorta in patients with bicuspid or tricuspid aortic valves

Hui, Sonya; Fan, Chun‐Po Steve; Christie, Shakira; Feindel, Christopher M.; David, Tirone E.; Ouzounian, Maral

doi:10.1016/j.jtcvs.2018.02.094

Cited by 24 publications

(24 citation statements)

References 35 publications

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“…The incidence of aortic surgical related complications after wrapping procedure is low, the surgical result from our experience registered no dilatation of the mid ascending or enlargement of the sinuses of Valsalva requiring reoperation, no aortic related complication such as dissection, death. Using our trimming technique, wrapping could be extended even few millimeters below the STJ and anchoring the vascular prosthesis proximally and distally will prevent it from dislocating as the few reported complication were mostly associated with the dislocation of the aortic wrap or an aortic root dilatation [9].…”

Section: Discussionmentioning

confidence: 99%

“…This method basically involves resection and replacement of the aneurysmal aorta with a vascular graft. Only replacement of dysfunctional aortic valve in patients with BAV may not be able to prevent progressive aortic dilation [9]. Modification to a reparative technique which includes replacing the aortic valve, decreasing the aortic diameter by excision of an oval segment, placing a well-tailored Dacron vascular graft around the ascending aorta, and anchoring it with previously placed sutures driven through the sewing ring of the valve prosthesis through the aortic wall, could done by a simple extravascular wrapping of the ascending aorta with a vascular graft may far useful particularly in geriatric subjects or individuals with high radical operative risks [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Zhu

Zhou

Xiao

et al. 2020

J Cardiothorac Surg

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Background: Evaluate the safety and efficacy of our modified technique of the extravascular procedure for treating mild to moderately dilated ascending aorta in patients with bicuspid aortic valve (BAV) aortopathy. Methods: From January 2015 to December 2018,119 consecutive patients with BAV and ascending aorta dilatation (dimension 40 mm~45 mm) were diagnosed in our institution. Among these,49 patients received aggressive aortic valve replace (AVR) + ascending aorta wrapped (wrapped group) while the other 70 patients received AVR + ascending aorta replacement (wheat group). All patients clinical and follow up data were collected for 12 months. Results: Aortic clamping and cardio-pulmonary bypass times were significantly longer in wheat group than wrap group (P < 0.001and 0.021,respectively). The first 24 h drainage in wheat group were much more than wrap group(P = 0.04). Ascending aorta diameter、left ventricular end diameter and ejection fraction were statistically different between pre-and post-operation (p < 0.001) in both groups, but the heart function and complication were no difference during follow up. Conclusions: External wrapping of the ascending aorta and wheat procedure have good short-term and long-term results in BAV patients with a mild to moderately dilated ascending aorta. The perioperative period results of external wrapping of the ascending aorta for BAV patients were encouraging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Zhu

Zhou

Xiao

et al. 2020

J Cardiothorac Surg

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“…[70][71][72] In a large single center cohort, BAV patients that had undergone either aortic valve replacement or ascending aorta replacement had no root dilatation at midterm follow-up of 8.1 § 5.4 years, negating the need for prophylactic aortic root replacement in these cases. 73…”

Section: Aortic Root and Ascending Aorta Surgerymentioning

confidence: 99%

Re: “Bicuspid Aortic Valve Associated Aortopathy: A Primer for Cardiac Anaesthesiologists”

Lenihan

Vegas

Buys

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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THE RECENT publication of The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy by Borger et al. 1 is the most comprehensive to date after several other publications. 2-5 We aim to provide a short synopsis of these guidelines with a particular focus on the potential implications for cardiothoracic anesthesiologists and the perioperative echocardiographers. Epidemiology Bicuspid aortic valve (BAV) is a common valve pathology with a prevalence of 1% to 2% in the general population; and a male to female predominance of 3:1. 6 It is the most common congenital cardiac lesion worldwide and causes more morbidity and mortality than all other congenital lesions combined. Despite this, appropriately managed patients diagnosed with BAV have a similar life expectancy to the normal population cohort. Valve dysfunction, aortopathy, or aortic dissection may complicate BAV. In addition, other coreported findings with BAV include Turner's and Williams syndromes, abnormal coronary anatomy (nondominant right coronaries adjacent to commissures), aortic coarctation, patent ductus arteriosus, and prolapse of the anterior leaflet of the mitral valve. Aortic valve function may be normal or generally deteriorates over time causing aortic stenosis (AS), aortic insufficiency (AI), or mixed lesions. BAV-AS is the commonest pathology presenting typically in older patients aged 50 to 70 years old, and BAV-AI occurs less often and predominantly in a younger patient cohort. The clinical findings in the BAV patient depend on native valve function and the presence or absence of associated lesions. The initial presentation of BAV varies, as patients may have asymptomatic auscultatory findings, or symptoms of valve dysfunction, bacterial endocarditis, or evidence of an aortic root or ascending aortic aneurysm, or be in extremis with acute aortic dissection. Patients with BAV-AS continue to be asymptomatic for a prolonged period. Those with severe AS may progress to the classic symptoms of dyspnea, decreased exercise tolerance, exertional dizziness, angina, and syncope. Patients with BAV-AI also may remain asymptomatic, though those with severe AI may present with atypical chest pain, palpitations, or dyspnea. Diagnosis The morphology of BAV varies resulting in different phenotypes that relate to the (1) orientation of the open cusps, (2) position of the commissures, and (3) the presence or absence of a raphe. Though several classification systems describe the BAV, the most frequently used is the Sievers' classification (Fig 1). 8 This classification system categorizes BAV into 3 subtypes based on the number of raphe present: Type 0, no raphe (6%), Type 1, one raphe (89%), and Type 2, 2 raphes (5%). Type 1 is the commonest and is further divided by the spatial position of the cusps into left-and right-coronary cusp fusion (71%), right-and noncoronary cusp fusion (15%), and non-and left-coronary cusp fusion (3%). 8 The resulting 2 functional cusps are usually asymmetric in size, and the nonfuse...

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“…The Toronto group of Hui and colleagues 1 have published in this issue of The Journal of Thoracic and Cardiovascular Surgery an intriguing study of their institution's experience across two decades with more than 400 patients undergoing aortic valve replacement for both bicuspid and tricuspid valves and concomitant ascending aorta replacement, frequently along with replacement of the noncoronary sinus. Ostensibly, this is the contemporary Toronto experience with their version of the Wheat procedure, which in most modern interpretations varies from the original description.…”

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confidence: 99%

“…2 Likewise, there are variations of the Bentall procedure, the operation that in some centers 3 might be the preferred approach for the cohort described by Hui and colleages. 1 We all have anecdotes of patients who underwent aortic valve replacement with an ascending aortic replacement, most often at another institution, and then presented to us later with significant aortic root enlargement requiring reoperation ( Figure 1). This type of patient has served as the fundamental rationale underpinning concomitant aortic root replacement in patients with bicuspid aortic valves undergoing aortic valve surgery for valid indications and varying degrees of aortopathy.…”

mentioning

confidence: 99%

The Wheat sprouts new life

Woo

Edmonson

2018

The Journal of Thoracic and Cardiovascular Surgery

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The aortic root does not dilate over time after replacement of the aortic valve and ascending aorta in patients with bicuspid or tricuspid aortic valves

Abstract: Mid-term imaging after aortic valve and ascending aorta replacement indicates that if the aortic root is not dilated at the time of surgery, the risk of enlargement over time is minimal, negating the need for prophylactic root replacement in patients with BAV or TAV.

Cited by 24 publications

References 35 publications

Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Surgical treatment of mild to moderately dilated ascending aorta in bicuspid aortic valve aortopathy: the art of safety and simplicity

Re: “Bicuspid Aortic Valve Associated Aortopathy: A Primer for Cardiac Anaesthesiologists”

The Wheat sprouts new life

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