Annals of cardiothoracic surgery最新文献

{"title":"Reflections on valve-sparing operations utilizing straight tube versus Valsalva grafts.","authors":"Hans-Hinrich Sievers, Michael Scharfschwerdt","doi":"10.21037/acs-2023-avs2-11","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-11","url":null,"abstract":"muscles (3). Furthermore, the downsized root diameters potentially lead to leaflet redundancy and leaflet folds often requiring surgical adaptation. How much correction of the leaflets in a non-distensible prosthesis is necessary? Together these factors prevent the leaflets from completely aligning and adhering to the wall but do not prevent the intermittent wall contact of the leaflets that was reported as a constant echocardiographic finding after the David operation with a straight tube (4), but not when a sinus was present (5). Magnetic resonance imaging confirmed these results and additionally found malrotated vortices behind the leaflets in a straight tube with unknown sequelae (3). In our experiments also","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 4","pages":"361-363"},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/40/49/acs-12-04-361.PMC10405340.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of aortic root replacement in patients with Marfan syndrome: the role of valve-sparing and valve-replacing approaches.","authors":"Joseph S Coselli,&nbsp;Irina V Volguina,&nbsp;Lynna Nguyen,&nbsp;Susan Y Green,&nbsp;Scott A LeMaire,&nbsp;Marc R Moon","doi":"10.21037/acs-2023-avs2-0085","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-0085","url":null,"abstract":"Background Marfan syndrome (MFS) is a heritable thoracic aortic disease with pervasive cardiovascular effects, including commonly, a dilated aortic root. Traditionally, the root is replaced using a mechanical composite valve graft (CVG); however, this valve-replacing (VR) approach necessitates a lifelong regimen of anticoagulation with a potential for late bleeding complications. In time, valve-sparing (VS) approaches were developed. Today, several options for aortic root replacement (ARR) exist; each has advantages and disadvantages that helps inform choice. The Aortic Valve Operative Outcomes in Marfan Patients (AVOMP) is a multi-center international registry to analyze clinical outcomes of ARR in MFS patients using either VR or VS techniques to better elucidate choice. We summarize outcomes of AVOMP and present our own experience. Methods We performed 223 consecutive elective ARR [1991–2023] in patients with MFS; 15 such repairs were included in AVOMP. Repairs included 113 (51%) using a mechanical CVG, 62 (28%) using a VS approach, and 48 (22%) using a bioprosthetic root. Many patients underwent aortic arch repair (30% to 54% by type). Results The median patient age was 38 [29–52] years. In comparing VS and VR groups, patients were similar in age and rates of major comorbidities and symptoms. Patients with VR repair had a more complex aortic history. The rate of redo sternotomy was 24% (n=54). Operative death was uncommon [4% overall (10/223); ranging from 2% to 8% by type], and stroke was rare [1/223 (<1%)]. Late survival and reoperation differed by operative approach; survival was improved in patients who underwent VS repair. Conclusions We found that repair in patients with MFS undergoing ARR resulted in low operative risk. Our late results were similar to those of AVOMP in that patients undergoing VS repair tended to experience greater rates of valvular-structural deterioration, although this did not appear to impact survival.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 4","pages":"338-349"},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b8/9f/acs-12-04-338.PMC10405346.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9956742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valve-sparing operations after Ross procedure: a single-center experience.","authors":"Jama Jahanyar,&nbsp;Bardia Arabkhani,&nbsp;Luca Zanella,&nbsp;Laurent de Kerchove,&nbsp;Peter I Tsai,&nbsp;Gaby Aphram,&nbsp;Stefano Mastrobuoni,&nbsp;Gebrine El Khoury","doi":"10.21037/acs-2023-avs2-0100","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-0100","url":null,"abstract":"<p><strong>Background: </strong>The Ross procedure has demonstrated excellent long-term results, with restoration of life-expectancy in patients with severe aortic valve dysfunction. However, reintervention after Ross can occur, and herein we describe our center's experience with redo surgery after previous Ross procedures.</p><p><strong>Methods: </strong>We searched our prospective database for aortic valve-repair and recruited all adult (≥18 years) patients who have undergone valve-sparing root replacements (VSRRs) and/or aortic valve-repair after Ross procedure between July 2001 and July 2022. Univariable logistic regression analysis was performed to identify variables affecting early mortality. Survival, freedom-from-valve-reintervention and freedom-from-aortic regurgitation (AR) grade ≥3 were analyzed with the Kaplan-Meier method.</p><p><strong>Results: </strong>A total of 63 patients were recruited for this study. Indication for reoperation after Ross was aortic aneurysm without AR in 17 (27%), aortic aneurysm with AR in 27 (43%), and isolated AR in 19 (30%) patients. Median follow-up time was 7.82 years. The majority of patients (76%) had undergone the free root technique during their index Ross operation. Cumulative survival, after redo surgery following Ross, was 98.4% [95% confidence interval (CI): 89.3-99.8%] at 1 year, 96.3% (95% CI: 88.2-98.3%) at 5 years, and 92.4% (95% CI: 87.1-98.0%) at 10 years. Freedom-from-reoperation on the aortic valve at 1 year was 98.4% (95% CI: 97.0-99.8%), at 5 years was 96.7% (95% CI: 87.6-99.0%), and 79.7% (95% CI: 71.1-88.3%) at 10 years.</p><p><strong>Conclusions: </strong>Long-term survival after redo surgery following the Ross operation is excellent. The data support our aggressive valve-sparing approach after Ross.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 4","pages":"350-357"},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/c7/acs-12-04-350.PMC10405345.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic root remodeling.","authors":"Christian Giebels,&nbsp;Tristan Ehrlich,&nbsp;Hans-Joachim Schäfers","doi":"10.21037/acs-2023-avs2-12","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-12","url":null,"abstract":"<p><p>Aortic root remodeling was originally designed in the late 1980s to treat patients with tricuspid aortic valves (TAVs), aortic regurgitation (AR), and root aneurysm to normalize root dimensions. The late results showed a relevant proportion of patients who required reoperation for recurrent AR. Later observations revealed that cusp prolapse is frequently present after correction of root dilatation. We showed that such prolapse could be detected by measuring effective height (eH) and corrected by concomitant cusp repair. In the past 13 years, we have added a suture annuloplasty to improve aortic valve function further. The operation starts with ascertaining adequate cusp size by measuring geometric cusp height. The dilated aortic wall is resected, and a Dacron graft is tailored to create three tongues. These tongues are sutured to the cusp insertion lines. Starting the suture in the nadir allows for easy extension of tongue length to avoid commissural height restriction. A suture annuloplasty is added at nadir level and tied around a Hegar dilator to normalize annular diameter. The valve is assessed visually and by measuring eH. Cusp prolapse (eH <9 mm) is frequent and corrected by free margin plication until all free margins are at equal level and eH is 9 mm. We have employed root remodeling in more than 710 instances of root aneurysm and TAVs. Mean myocardial ischemic time has been 65±13 minutes for isolated remodeling, operative mortality has been 1.5% for elective procedures. With suture annuloplasty, 10-year freedom from reoperation is 95%, even without suture annuloplasty 20-year freedom from reoperation is 85%. In our experience, root remodeling has been a valid form of valve-preserving surgery with low morbidity and mortality and excellent long-term results.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 4","pages":"369-376"},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5e/89/acs-12-04-369.PMC10405338.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From valve-sparing aortic root replacement to aortic root reconstruction: the importance of aortic valve repair.","authors":"Charles Laurin,&nbsp;Elbert Williams,&nbsp;Ismail El-Hamamsy","doi":"10.21037/acs-2023-avs2-20","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-20","url":null,"abstract":"As the term aptly describes, valve-sparing aortic root replacement (VSRR) was initially designed to address patients with primary aortic root pathology and very little to no aortic valve (AV) dysfunction. If present, any degree of aortic insufficiency (AI) was secondary to dilatation of the aortic annulus and/or the sinotubular junction (STJ), in association with the aneurysm of the sinuses of Valsalva. Restoring the anatomy of the aortic root components would thus restore AV function. However, it is important to remember that the functional aortic root is composed of four inter-related parts: the virtual basal ring, the STJ, the sinuses of Valsalva, as well as the AV cusps. In patients with aneurysms of the sinuses of Valsalva, there are inevitably compensatory or pathological changes in the structure of the AV cusps in response to the changes in aortic root dimensions, ranging from elongation to stress fenestrations, especially in areas of high stress near the commissures. Thus, it became evident that restoring the dimension of the annulus and STJ without any attention to the last component parts of the aortic root could result in early failure of a VSRR, including in patients with seemingly normal AV function preoperatively (1). This commenced the era of AV repair. It was soon recognized that residual or induced prolapse of the AV cusps after completion of the VSRR was associated with recurrence of AI and need for reintervention (1). Indeed, as the aortic root dilates and becomes aneurysmal, AV cusps adapt to different extents, which explains the wide variations in severity of AI in patients with similarly sized aortic root aneurysms. Aortic cusps elongate in both their radial and circumferential axes through active, living processes (2). Failure to recognize this at the time of VSSR, and instead restoring to normal AV cusp configuration (effective height, coaptation length and symmetry), as described by the pioneering work of the Brussels and Homburg teams, will lead to failure of the seemingly most straight-forward VSRR procedures for aortic root aneurysms in patients with tricuspid aortic valve (TAV) (3-5). As the applications of VSRR have expanded, a wider group of patients should be considered for these procedures, namely patients with bicuspid aortic valves (BAV) or those with TAVs and eccentric jets of AR. In both instances, there is invariably some element of abnormal cusp structure, typically in the form of cusp prolapse. This is true in the majority of patients with regurgitant BAVs. As has been known in the mitral world for many years, failure to correct cusp prolapse at the time of surgery will negatively impact the durability of the operation. Concepts of BAV preservation and repair are increasingly well understood and standardized (6,7). There is no doubt that most VSRR operations today for patients with BAV and significant AI should involve some element of cusp repair, ranging from raphe release to increase geometric height and ","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 4","pages":"364-365"},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3a/6c/acs-12-04-364.PMC10405337.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe aortic valve insufficiency with a 'normal' appearing aortic root: reimplantation (David) procedure.","authors":"Munir Boodhwani,&nbsp;Ming Hao Guo,&nbsp;Adam Dryden,&nbsp;David Glineur","doi":"10.21037/acs-2023-avs2-14","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-14","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 4","pages":"377-379"},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/81/acs-12-04-377.PMC10405333.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mini-access David Procedure with endoscopic assessment of aortic valve competency: the \"Snorkelling\" technique.","authors":"Victoria Cook,&nbsp;Mathew Doyle,&nbsp;Tristan D Yan","doi":"10.21037/acs-2023-avs2-0101","DOIUrl":"https://doi.org/10.21037/acs-2023-avs2-0101","url":null,"abstract":"A 58-year-old man was referred with an incidental finding of an aortic root aneurysm. He had no significant medical history. Computed tomography (CT) aortogram demonstrated an isolated aortic root aneurysm (aortic annulus 28 mm, aortic root 53 mm, sinotubular junction 53 mm). Transthoracic echocardiogram demonstrated a dilated aortic root and a tri-leaflet aortic valve with mild aortic regurgitation (AR). The left ventricular (LV) ejection fraction was preserved. Cardiac catheterization demonstrated mild non-obstructive coronary artery disease only. Given the patients’ age, structurally normal-appearing valve and borderline annular dimension, minimally-invasive aortic valve reimplantation was planned. The minimally invasive approach was based on surgeon and patient preference.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 4","pages":"389-391"},"PeriodicalIF":3.1,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/9e/acs-12-04-389.PMC10405336.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9963098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromonitoring for descending thoracic and thoracoabdominal aortic aneurysm repair","authors":"A. Tanaka, H. Nguyen, Holly N. Smith, A. Estrera","doi":"10.21037/asvide.2023.151","DOIUrl":"https://doi.org/10.21037/asvide.2023.151","url":null,"abstract":"A forty-four-year-old female presented with an extent II thoracoabdominal aortic aneurysm (TAAA) and lower back pain. Computed tomography demonstrated contained rupture of the 10 cm infrarenal abdominal aorta. The proximal descending aorta (DTA) was 5.5 cm in diameter but the aortic segment T8 to T12 was 3 cm in diameter. Thus, staged repair of the TAAA was planned. The patient successfully underwent first-stage, extent IV TAAA repair, which includes replacement of the aorta from T12 proximally to right iliac and left common femoral distally with bypass to the visceral/renal arteries. There were no motor evoked potentials (MEPs) or somatosensory evoked potentials (SSEPs) changes. All the patent lumbar arteries were ligated. Her postoperative course was uneventful. After ten days of recovery, the patient was taken back to the operating room for the second stage, completion of the extent II TAAA repair.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 1","pages":"509 - 510"},"PeriodicalIF":3.1,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46709406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe aortic valve insufficiency with a ‘normal’ appearing aortic root: reimplantation (David) procedure","authors":"M. Boodhwani, Ming Guo, A. Dryden, D. Glineur","doi":"10.21037/asvide.2023.116","DOIUrl":"https://doi.org/10.21037/asvide.2023.116","url":null,"abstract":"sutures were placed. Valve inspection revealed a trileaflet aortic valve with thickening of the free margins of all three cusps. The cusps were mobile with no obvious fenestrations or calcification. Inspection of the left cusp suggested some degree of prolapse, with bending of the cusp and the presence of a fibrous band. Inspection of the aortic root revealed normal quality tissue, except in the area of the VAJ under the right coronary cusp. The geometric heights of the left, right, and non-coronary cusps measured 18, 21, and 20 mm, respectively. A 6-0 prolene suture was used to retract the ventricular surface of the cusps and the thickened portion of the leaflets was shaved off with a #11 blade to improve cusp mobility. External dissection of the aortic root was performed to enable access to the VAJ at which level the annuloplasty needs be performed. We started with the non-coronary sinus, dissecting down to the level of leaflet insertion. The sinus was resected, leaving behind a 5–7 mm rim of aortic tissue. A similar dissection was performed after harvesting the right coronary button, followed by the left coronary button. The pulmonary artery and right ventricle were detached from the aortic root. A deep dissection (3) was performed by going through the aorto-pulmonary ligament, which is the white fibrous tissue followed by yellowish fat tissue underneath and then into","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 1","pages":"377 - 379"},"PeriodicalIF":3.1,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42265962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open repair of a thoracoabdominal aortic aneurysm using hypothermic cardiopulmonary bypass and circulatory arrest","authors":"N. Kouchoukos","doi":"10.21037/asvide.2023.114","DOIUrl":"https://doi.org/10.21037/asvide.2023.114","url":null,"abstract":"A 78-year-old female presented with recent onset of interscapular chest pain. She was a smoker and had previously undergone coronary artery stenting. Left ventricular function was normal. A computed tomography (CT) angiogram showed aneurysmal degeneration of the distal descending thoracic and the entire abdominal aorta. There were high-grade stenoses at the origins of the celiac, superior mesenteric, and both renal arteries. This was classified as a Crawford extent III thoracoabdominal aortic aneurysm.","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"12 1","pages":"506 - 508"},"PeriodicalIF":3.1,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49591335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}