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J Thorac Cardiovasc Surg 2001;122:39-46
© 2001 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Divisions of Cardiovascular Surgery and Cardiology of Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Received for publication May 15, 2000. Revisions requested June 21, 2000; revisions received Sept 14, 2000. Accepted for publication Nov 9, 2000. Address for reprints: Tirone E. David. MD, 200 Elizabeth St, 13EN219, Toronto, Ontario, Canada M5G 2C4 (E-mail: tirone.david{at}uhn.on.ca).
Abstract
Objective: To review the late results of valve-sparing operations in patients with aortic root aneurysm and in those with ascending aortic aneurysm and aortic insufficiency.
Methods: From May 1988 to June 2000, 120 patients with aortic root aneurysm and 68 with ascending aortic aneurysm and aortic insufficiency underwent aortic valve–sparing operations. Patients with aortic root aneurysm were younger, were predominantly male, and had less severe aortic insufficiency than patients with ascending aortic aneurysm, who were older and often had aneurysm of the transverse arch. Forty-eight patients with aortic root aneurysm had the Marfan syndrome. The prevalence of aortic dissection was similar in both groups. Reconstruction of the aortic root was performed by reimplanation of the aortic valve in 64 patients and by remodeling of the aortic root in 56. Patients with ascending aortic aneurysm and aortic insufficiency were treated by replacement of the ascending aorta with reduction in the diameter of the sinotubular junction. Approximately two thirds of the latter patients also required replacement of the transverse aortic arch. The mean follow-up was 35 ± 31 months for patients with aortic root aneurysm and 26 ± 23 months for those with ascending aortic aneurysm.
Results: There were 2 operative and 5 late deaths in patients with aortic root aneurysm and 1 operative and 9 late deaths in patients with ascending aortic aneurysm. The 5-year survival for patients with aortic root aneurysm was 88% ± 4% and for patients with ascending aortic aneurysm, 68% ± 12% (P = .01). Severe aortic insufficiency developed in 2 patients, and they required aortic valve reoperation. The 5-year freedom from aortic valve reoperation was 99% ± 1% for patients with aortic root aneurysm and 97% ± 4% for those with ascending aortic aneurysm. Seven patients had moderate aortic insufficiency at the latest echocardiographic study. The 5-year freedom from severe or moderate aortic insufficiency was 90% ± 4% in patients who had aortic root aneurysm and 98% ± 2% in those who had ascending aortic aneurysm.
Conclusions: Aortic valve–sparing operations have provided excellent clinical outcomes and few valve-related complications. The function of the reconstructed aortic root remains unchanged in most patients during the first 5 years of follow-up.
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G. R. Green and I. L. Kron Aortic Dissection Card. Surg. Adult, January 1, 2003; 2(2003): 1095 - 1122. [Full Text]
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H. Matsuda, H. Ichikawa, S. Iwai, and T. Takahashi Modified aortic root remodeling for annuloaortic ectasia with abnormal coronary take-off Ann. Thorac. Surg., November 1, 2002; 74(5): 1687 - 1689. [Abstract] [Full Text] [PDF]
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H.-J. Schafers, D. Aicher, and F. Langer Correction of leaflet prolapse in valve-preserving aortic replacement: pushing the limits? Ann. Thorac. Surg., November 1, 2002; 74(5): S1762 - 1764. [Abstract] [Full Text] [PDF]
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K. Kallenbach, M. Karck, R. G. Leyh, C. Hagl, T. Walles, W. Harringer, and A. Haverich Valve-sparing aortic root reconstruction in patients with significant aortic insufficiency Ann. Thorac. Surg., November 1, 2002; 74(5): S1765 - 1768. [Abstract] [Full Text] [PDF]
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J. S. Ikonomidis and D. C. Miller Stentless bioprosthetic aortic valve replacement after valve-sparing aortic root replacement J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 848 - 851. [Full Text] [PDF]
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R. De Paulis, G. M. De Matteis, P. Nardi, R. Scaffa, C. Bassano, and L. Chiariello Analysis of valve motion after the reimplantation type of valve-sparing procedure (David I) with a new aortic root conduit Ann. Thorac. Surg., July 1, 2002; 74(1): 53 - 57. [Abstract] [Full Text] [PDF]
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T. E. David Aortic valve sparing operations Ann. Thorac. Surg., April 1, 2002; 73(4): 1029 - 1030. [Full Text] [PDF]
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K. Morishita, G. Murakami, T. Koshino, J. Fukada, Y. Fujisawa, T. Mawatari, and T. Abe Aortic root remodeling operation: how do we tailor a tube graft? Ann. Thorac. Surg., April 1, 2002; 73(4): 1117 - 1121. [Abstract] [Full Text] [PDF]
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T. E. David, J. Ivanov, M. J. Eriksson, J. Bos, C. M. Feindel, and H. Rakowski Dilation of the sinotubular junction causes aortic insufficiency after aortic valve replacement with the Toronto SPV bioprosthesis J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 929 - 934. [Abstract] [Full Text] [PDF]
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