Unicuspid valve repair—what technique, which patch for which patient?

Matsushima, Shunsuke; Giebels, Christian; Glenske, Maximilian; Karliova, Irem; Schäfers, Hans‐Joachim

doi:10.21037/acs.2019.05.04

Cited by 12 publications

(10 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two triangular patches are prepared to bridge the gaps between preserved left or non-coronary cusp tissue and the new commissure, most commonly using glutaraldehyde-fixed autologous pericardium [ 20 ], decellularized xenogeneic tissue (Matrix Patch; Auto Tissue Berlin GmbH, Berlin, Germany) or expanded polytetrafluoroethylene (PTFE) membranes (Gore Preclude Pericardial Membrane; W.L. Gore & Assoc., Newark, DE, USA) [ 12 ] (Table 3 A). Six patients underwent root remodelling with cusp nadir relocation and without the use of patch material.…”

Section: Methodsmentioning

confidence: 99%

“…Repair is one alternative; the durability of unicuspid valve repair in a younger patient population has been suboptimal [ 2 , 12 , 13 ], and reoperations have been primarily related to patch degeneration [ 2 , 3 , 12 , 14 ]. The Ross procedure has become of interest in the last decade, in particular as a replacement option for valves that cannot be repaired [ 9 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Ross procedure versus repair for treatment of a unicuspid aortic valve in adults

Abeln

Matsushima

Ehrlich

et al. 2023

European Journal of Cardio-Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

Background Aortic stenosis or regurgitation in patients with a unicuspid valve morphology require interventions early in life. We have performed either primary valve repair or the Ross procedure. The aim of this study was to compare the mid-term results of repair and pulmonary autograft replacement. Methods Between 12/1998 and 04/2022, 345 patients (77% male; mean age 34±9.7 years) underwent treatment of a unicuspid aortic valve. Patients were excluded if they were <18 years (n = 84) or > 54 years (n = 3) at the time of the operation. The remaining cohort was divided into 2 groups: 167 (64%) patients underwent valve repair, 91 (36%) patients underwent pulmonary autograft replacement. The indications for surgery were aortic regurgitation (n = 104), aortic stenosis (n = 45), combined disease (n = 103), and endocarditis (n = 6). Fifty-one patients had root dilatation (>43mm) with aortic regurgitation (repair n = 23; Ross n = 28). Mean follow-up was 5.9 (SD: 5 years) [range 0.1 to 22.3 years]. Results There was 1 early, 3 late deaths, and 47 patients required reintervention. Survival at 10 years was 95% in the Ross group and 97% after valve repair (p = 0.769). Freedom from reintervention at 10 years was 98% in the Ross group and 80% after valve repair (p = 0.012). A ROC curve analysis showed a trend towards better durability in patients < 26 years. Conclusion The ideal treatment of the unicuspid aortic valve remains debatable. Repair of a unicuspid valve can be considered a bridge to pulmonary autograft replacement, at least in younger patients. The appropriate time when to replace and when to repair requires further investigation.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Ross procedure versus repair for treatment of a unicuspid aortic valve in adults

Abeln

Matsushima

Ehrlich

et al. 2023

European Journal of Cardio-Thoracic Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…The bicuspidization technique was performed as described elsewhere ( 10 ). Briefly, the anterior part of the leaflet adjacent to two residual commissures was resected and a new commissure was formed using various materials: autologous pericardium (fresh or preserved in glutaraldehyde), xenologous pericardium, CardioCel (Admedus, Tissue Berlin GmbH, Berlin, Germany), Matrix-auto tissue (Auto Tissue Berlin GmbH, Berlin, Germany).…”

Section: Methodsmentioning

confidence: 99%

“…Only the Ross patients who could be retrospectively suitable for bicuspidization were selected for the secondary analysis. The criteria for selection were in accordance with those proposed by Schäfers et al (10): (i) the larger part of each cusp is composed of a native cusp tissue; (ii) the corresponding cusp tissue has sufficient mobility; (iii) cusp tissue is not calcified or calcification is limited to the part resected during bicuspidization procedure. The intraoperative criteria (native cusp geometric height) could not be utilized as this selection was limited to retrospective preoperative echocardiographic review.…”

Section: Primary and Secondary Analysismentioning

confidence: 99%

Comparison of bicuspidization and Ross procedure in the treatment of unicuspid aortic valve disease in adults – Insight from the AVIATOR registry

Gofus

Karalko

Fila

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

BackgroundUnicuspid aortic valve (UAV) is the second most common underlying cause of aortic valve dysfunction in young adults after the bicuspid valve. The valve may be replaced (for example by pulmonary autograft) or repaired using the bicuspidization technique. The aim of our study was to compare short- and mid-term outcomes of Ross procedure with bicuspidization in patients with severe UAV dysfunction.MethodsThis was a multi-center retrospective observational cohort study comparing data from two dedicated Ross centers in the Czech Republic with bicuspidization outcomes provided by AVIATOR registry. As for the Ross group, only the patients with UAV were included. Primary endpoint was mid-term freedom from reintervention. Secondary endpoints were mid-term freedom from major adverse events, endocarditis and pacemaker implantation.ResultsThroughout the study period, 114 patients underwent the Ross procedure (years 2009-2020) and 126 patients underwent bicuspidization (years 2006-2019). The bicuspidization group was significantly younger and presented with a higher degree of dyspnea, a lower degree of aortic valve stenosis and more often with pure regurgitation. The primary endpoint occurred more frequently in the bicuspidization group than in the Ross group – 77.9 vs. 97.9 % at 5 years and 68.4 vs. 75.2 % at 10 years (p < 0.001). There was no difference in secondary endpoints.ConclusionRoss procedure might offer a significantly lower mid-term risk of reintervention than bicuspidization in patients with UAV. Both procedures have comparable survival and risk of other short- and mid-term complications postoperatively.

show abstract

“…So far, only mid-term results of such a repair are available [ 45 •]. The early function of the valve has generally been good but degeneration of the pericardium used as cusp replacement has been the limiting factor for valve stability with a mean durability of slightly more than 10 years [ 46 ]. With other material, such as expanded polytetrafluoroethylene, the results have been worse [ 47 ].…”

Section: Specific Considerationsmentioning

confidence: 99%

Which Aortic Valve Can Be Surgically Reconstructed?

et al. 2021

Self Cite

View full text Add to dashboard Cite

Purpose of Review Preservation or repair of the aortic valve has evolved dynamically in the past 20 years. It leads to a high freedom from valve-related complications if an adequate valve durability can be achieved; it may possibly also improve survival. To date, little structured information is available about which valves can be repaired and which should better be replaced. Recent Findings For surgical decision-making, the size of the aortic root is important and the anatomy of the aortic valve must be considered. In the presence of root aneurysm, most tricuspid and bicuspid aortic valves can be preserved. In aortic regurgitation and normal aortic dimensions, the majority of tricuspid and bicuspid aortic valves can be repaired with good long-term durability. In bicuspid aortic valves, the morphologic characteristics must be taken into consideration. Unicuspid and quadricuspid aortic valves can be repaired in selected cases. Generally, cusp calcification is a sign of a poor substrate for repair; the same is true for cusp retraction and cusp destruction due to active endocarditis. They are associated with limited valve durability. Summary Using current concepts, many non-calcified aortic valves can be repaired. Modern imaging, in particular three-dimensional transesophageal echocardiography (TEE), should be able to define repairable aortic valves with a high probability.

show abstract

Unicuspid valve repair—what technique, which patch for which patient?

Cited by 12 publications

References 5 publications

The Ross procedure versus repair for treatment of a unicuspid aortic valve in adults

The Ross procedure versus repair for treatment of a unicuspid aortic valve in adults

Comparison of bicuspidization and Ross procedure in the treatment of unicuspid aortic valve disease in adults – Insight from the AVIATOR registry

Which Aortic Valve Can Be Surgically Reconstructed?

Contact Info

Product

Resources

About