Y-incision Aortic Root Enlargement With Modified Aortotomy Upsizing the Annulus by 5 Valve Sizes

Yang, Bo; Ghita, Corina; Palmer, Sarah Jane

doi:10.1016/j.athoracsur.2022.03.013

Cited by 23 publications

(17 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Aortic root enlargement is currently performed in 10% of cases [ 27 ] via different surgical methods such as the extension of the aortotomy posteriorly, either through the non-coronary sinus (Nicks procedure) or through the left/non-coronary commissure and the anterior mitral leaflet (Manouguian procedure), or the use of the Konno procedure (seldom performed in adult patients), which augments the anterior annulus and the right ventricle [ 28 , 29 , 30 ]. More recently, a root enlargement with a Y incision has been proposed [ 31 ]. Replacing the aortic root during SAVR can also prevent patient–prosthesis mismatch and is safe without extra risk in centres with adequate experience, but its long-term benefits are still uncertain [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis

Abbasciano,

Magouliotis,

Koulouroudias

et al. 2024

JCM

View full text Add to dashboard Cite

Indication to perform surgical explantation of TAVR is becoming increasingly more frequent, due to the higher number of transcatheter procedures performed in patients with longer life expectancy. We proposed to perform a systematic review and meta-analysis with metaregression to identify potential factors that can determine an increase in the high mortality and morbidity that characterize these surgical procedures. MEDLINE and Embase were searched for relevant studies. Twelve studies were eligible according to our inclusion criteria. TAVR explantation was confirmed as a procedure with high 30-day mortality (0.17; 95% CI, 0.14–0.21) and morbidity (stroke incidence 5%; 95% CI, 0.04–0.07; kidney injury incidence 16%; 95% CI, 0.11–0.24). The type of transcatheter valve implanted during the index procedure did not influence the outcomes after surgical explantation. The role of these high-risk operations is growing, and it will likely expand in the coming years. Specific tools for risk stratification are required.

show abstract

Section: Resultsmentioning

confidence: 99%

Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis

Abbasciano,

Magouliotis,

Koulouroudias

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…SAVR provides the opportunity to up-size the valve, particularly with newer aortic root enlargement techniques. For example, the Y incision and roof patch technique described by Yang et al ( 26 – 29 ) which can increase the implanted valve by five valve sizes to provide patients optimize hemodynamics, longevity of the bioprosthesis, and a better platform for future ViV TAVR. Although aortic root enlargement has not been widely adopted, it is now more commonly performed in the TAVR era.…”

Section: Discussionmentioning

confidence: 99%

Trends in surgical aortic valve replacement in pre- and post-transcatheter aortic valve replacement eras at a structural heart center

Norton

Ward

Tully

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThe advent of transcatheter aortic valve replacement (TAVR) has directly impacted the lifelong management of patients with aortic valve disease. The U.S. Food and Drug Administration has approved TAVR for all surgical risk: prohibitive (2011), high (2012), intermediate (2016), and low (2019). Since then, TAVR volumes are increasing and surgical aortic valve replacements (SAVR) are decreasing. This study sought to evaluate trends in isolated SAVR in the pre- and post-TAVR eras.MethodsFrom January 2000 to June 2020, 3,861 isolated SAVRs were performed at a single academic quaternary care institution which participated in the early trials of TAVR beginning in 2007. A formal structural heart center was established in 2012 when TAVR became commercially available. Patients were divided into the pre-TAVR era (2000–2011, n = 2,426) and post-TAVR era (2012–2020, n = 1,435). Data from the institutional Society of Thoracic Surgeons National Database was analyzed.ResultsThe median age was 66 years, similar between groups. The post-TAVR group had a statistically higher rate of diabetes, hypertension, dyslipidemia, heart failure, more reoperative SAVR, and lower STS Predicted Risk of Mortality (PROM) (2.0% vs. 2.5%, p < 0.0001). There were more urgent/emergent/salvage SAVRs (38% vs. 24%) and fewer elective SAVRs (63% vs. 76%), (p < 0.0001) in the post-TAVR group. More bioprosthetic valves were implanted in the post-TAVR group (85% vs. 74%, p < 0.0001). Larger aortic valves were implanted (25 vs. 23 mm, p < 0.0001) and more annular enlargements were performed (5.9% vs. 1.6%, p < 0.0001) in the post-TAVR era. Postoperatively, the post-TAVR group had less blood product transfusion (49% vs. 58%, p < 0.0001), renal failure (1.4% vs. 4.3%, p < 0.0001), pneumonia (2.3% vs. 3.8%, p = 0.01), shorter lengths of stay, and lower in-hospital mortality (1.5% vs. 3.3%, p = 0.0007).ConclusionThe approval of TAVR changed the landscape of aortic valve disease management. At a quaternary academic cardiac surgery center with a well-established structural heart program, patients undergoing isolated SAVR in the post-TAVR era had lower STS PROM, more implantation of bioprosthetic valves, utilization of larger valves, annular enlargement, and lower in-hospital mortality. Isolated SAVR continues to be performed in the TAVR era with excellent outcomes. SAVR remains an essential tool in the lifetime management of aortic valve disease.

show abstract

“…The index case report [ 48 ] showed an increase of two valve sizes, with subsequent case reports showing increases of three [ 56 ], four [ 57 ] and five valve sizes [ 58 ], as the authors increased in experience with the procedure. Early outcomes of 50 consecutive patients undergoing the Yang technique have been reported.…”

Section: Contemporary Developments In Are: the Yang Proceduresmentioning

confidence: 99%

Prosthesis–Patient Mismatch and Aortic Root Enlargement: Indications, Techniques and Outcomes

Fazmin,

Ali

2023

JCDD

View full text Add to dashboard Cite

Prosthesis–patient mismatch (PPM) is defined as implanting a prosthetic that is insufficiently sized for the patient receiving it. PPM leads to high residual transvalvular gradients post-aortic valve replacement and consequently results in left ventricular dysfunction, morbidity and mortality in both the short and long term. Younger patients and patients with poor preoperative left ventricular function are more vulnerable to increased mortality secondary to PPM. There is debate over the measurement of valvular effective orifice area (EOA) and variation exists in how manufacturers report the EOA. The most reliable technique is using in vivo echocardiographic measurements to create tables of predicted EOAs for different valve sizes. PPM can be prevented surgically in patients at risk through aortic root enlargement (ARE). Established techniques include the posterior enlargement through Nicks and Manouguian procedures, and aortico-ventriculoplasty with the Konno–Rastan procedure, which allows for a greater enlargement but carries increased surgical risk. A contemporary development is the Yang procedure, which uses a Y-shaped incision created through the non- and left-coronary cusp commissure, undermining the nadirs of the non- and left-coronary cusps. Early results are promising and demonstrate an ability to safely increase the aortic root by up to two to three sizes. Aortic root enlargement thus remains a valuable and safe tool in addressing PPM, and should be considered during surgical planning.

show abstract

Y-incision Aortic Root Enlargement With Modified Aortotomy Upsizing the Annulus by 5 Valve Sizes

Cited by 23 publications

References 3 publications

Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis

Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis

Trends in surgical aortic valve replacement in pre- and post-transcatheter aortic valve replacement eras at a structural heart center

Prosthesis–Patient Mismatch and Aortic Root Enlargement: Indications, Techniques and Outcomes

Contact Info

Product

Resources

About