Use of the Valsalva graft and long-term follow-up

Paulis, Ruggero De; Scaffa, Raffaele; Nardella, Saverio; Maselli, Daniele; Weltert, Luca; Bertoldo, Fabio; Pacini, Davide; Settepani, Fabrizio; Tarelli, Giuseppe; Gallotti, Roberto; Bartolomeo, Roberto Di; Chiariello, Luigi

doi:10.1016/j.jtcvs.2010.07.060

Cited by 66 publications

(49 citation statements)

References 22 publications

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“…Thus, adding the sinus structure to the semilunar valve root to enhance the semilunar valve function was believed to be reasonable. Among the adult population, it was common to use the "Valsalva graft" for valve-sparing aortic root replacement to preserve the spared aortic valve function [15]. However, the concerns of creating bulging sinuses on the valved ePTFE conduit for RVOT reconstruction have included its safety and efficacy.…”

Section: Commentmentioning

confidence: 99%

Valved Polytetrafluoroethylene Conduits for Right Ventricular Outflow Tract Reconstruction

Shinkawa

Tang

Gossett

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Valved Polytetrafluoroethylene Conduits for Right Ventricular Outflow Tract Reconstruction

Shinkawa

Tang

Gossett

et al. 2015

The Annals of Thoracic Surgery

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“…Following remodeling, freedom from moderate or severe AI at 10 years was 64 % in the study by Yacoub et al, 25 96 % for bicuspid valves, and 87 % for tricuspid valves as reported by Aicher et al 26 Following reimplantation, freedom from reoperation at 10 years was 93 % for David et al 27 and 88 % for De Paulis et al 28 Aortic valve sparing operations have been shown to have good long-term outcomes in experienced centers and offer the ability to maintain the patient's native valve.…”

Section: Outcomes For Aortic Valve Repair and Valve Sparing Aortic Romentioning

confidence: 84%

Surgical Approaches to Aortic Valve Replacement and Repair—Insights and Challenges

Ramlawi

Ramchandani

Reardon

2011

Interventional Cardiology Review

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Since 1960, surgical aortic valve replacement (sAVR) had been the only effective treatment for symptomatic severe aortic stenosis until the recent development of transcatheter aortic valve replacement (TAVR). TAVR has offered an alternative, minimally invasive treatment approach particularly for patients whose age or co-morbidities make them unsuitable for sAVR. The rapid and enthusiastic utilization of this new technique has triggered some speculation about the imminent demise of sAVR. We believe that despite the recent advances in TAVR, surgical approach to aortic valve replacement has continued to develop and will continue to be highly relevant in the future.This article will discuss the recent developments and current approaches for sAVR, and how these approaches will keep pace with catheter-based technologies.

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“…31) De Paulis states that the rate of freedom from aortic valve reoperation at 10 years after VSRR using the Valsalva graft is 91%. 32) Urbanski described another novel technique in which each pathological sinus is excised and replaced with a teardrop-shaped patch. 33) Hess and colleagues developed the Florida sleeve, which is another less invasive approach.…”

Section: Various Vsrr Techniquesmentioning

confidence: 99%

Valve-sparing Aortic Root Replacement

Shimizu

Yozu

2011

Ann Thorac Cardiovasc Surg

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The aortic root has a unique 3-dimensional configuration and the distinctive function of supporting the aortic valve and blood vessels. The sinuses of Valsalva are crucial to create appropriate eddy currents that are important in initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Most aneurysms in the aortic root are associated with degenerative changes in the elastic media rather than atherosclerosis. Valvesparing root repair has become widely accepted, although the Bentall procedure remains the gold standard. Because reimplantation using the Valsalva graft allows root geometry to be retained and theoretically and practically prevents recurrent aortic valve regurgitation, it is considered the most reliable and preferred technique among various valve-sparing aortic root repair procedures. Ann Thorac Cardiovasc Surg 2011; 17: 330-336 doi: 10.5761/atcs.ra.11.01675 Anatomy of the Aortic RootThe aortic root is the most proximal part of the aorta. It has a unique 3-dimensional (3D) configuration with a clover-like dilation of the sinuses of Valsalva within which the aortic valve forms a three-pronged crown. The attachment of each valve leaflet to the aortic wall is semilunar, running from the basal attachment within the left ventricle to the distal attachment at the sinotubular (ST) junction. The virtual circle connecting the lowest point on each semilunar attachment is called the basal ring. The posterior half of the basal ring (including the base of the non-coronary sinus) is fibrous, and the anterior half (including the base of the left and right coronary sinuses) is muscular. The fibrous portion is considered weaker and easy to dilate. The semilunar attachment forms a hemodynamic (but not an anatomical) junction between the left ventricle and the aorta. The anatomical ventriculo-aortic junction is the circle lying a little above the basal ring (Fig. 1).1) The bundle of His lies immediately below the membranous ventricular septum that lies immediately beneath the commissure between the right and noncoronary cusps (Fig. 2).2-4) The diameter of the aorta at the ST junction is 81% of the diameter at the aortic sinuses, and 97% at the basal ring. 5) Function of Aortic RootThe aortic root not only channels blood but also supports the aortic valve leaflets. The clover-like dilation of sinuses of Valsalva is crucial to create appropriate eddy currents in the supravalvular region, which are important for initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Etiology and Pathology of the Aortic RootMost aneurysms in the aortic root are associated with degenerative changes in the elastic media, although atherosclerosis is the major etiology of aneurysms in other regions of the aorta. This probably correlates with the higher concentration of elastic fibers in the media of the aortic root. Cystic medial degeneration, or elastic fiber fragmentation and smooth muscle loss, are typical of the histological characteristics of root aneurysms. Aortic root...

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Use of the Valsalva graft and long-term follow-up

Abstract: The reimplantation type of valve-sparing procedure can be facilitated by the use of the Valsalva graft and can be performed with satisfactory perioperative and midterm results. How an optimal root reconstruction will affect the second decade of follow-up has yet to be determined.

Cited by 66 publications

References 22 publications

Valved Polytetrafluoroethylene Conduits for Right Ventricular Outflow Tract Reconstruction

Valved Polytetrafluoroethylene Conduits for Right Ventricular Outflow Tract Reconstruction

Surgical Approaches to Aortic Valve Replacement and Repair—Insights and Challenges

Valve-sparing Aortic Root Replacement

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