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Aortic Valve Repair and Root Preservation by Remodeling, Reimplantation, and Tailoring: Technical Aspects and Early Otcome
Author(s) -
Svensson Lars G.,
Deglurkar Indu,
Ung Jin,
Pettersson Gosta,
Gillinov A. Marc,
D'Agostino Richard S.,
Lytle Bruce W.
Publication year - 2007
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2007.00467.x
Subject(s) - medicine , aortic valve regurgitation , surgery , bicuspid aortic valve , bentall procedure , aortic valve , aortic valve repair , perforation , commissure , aortic root , cardiac skeleton , regurgitation (circulation) , elephant trunks , cardiology , aortic arch , aorta , anatomy , punching , materials science , metallurgy
Objectives: Evaluate aortic root preserving/sparing procedures for various pathologies associated with ascending aortic aneurysms, including aortic valve regurgitation. Methods: From the end of 1990 through end of 2004, 388 patients had aortic root preserving procedures (reimplantation 72, remodeling 77, tailoring 239) ± leaflet repair. Preoperatively, in‐house grade aortic regurgitation was 1 + in 58, 2 + in 110, 3 + in 101, and 4 + in 66. Concurrent leaflet repairs were done in 197 (50.8%, Cabrol/Trusler commissure stitch 158, leaflet plication 36, supracommissure stitch 42, leaflet resection and repair 16, perforation repair 18, and debridement 11). Additional procedures included arch repair in 227 (58%), coronary bypass in 83 (21.4%), elephant trunk in 33 (8.5%), and minimally invasive approach in 30 (7.7%). Pathologies included dissection in 140 (36%; 86 acute), Marfan syndrome in 39 (10%), bicuspid valve in 78 (20%), and degenerative aneurysm in 142 (36.6%). The CLASS (Commissure, Leaflet, Annulus, Sinuses, Sinotubular) evaluation schema is described that is used for selecting either reimplantation, remodeling, or tailoring of the aortic root according to underlying pathology. Results: Hospital survival was 97.4% (378/388) and stroke occurred in 4.6% (18/388, four permanent, [1%]). On postoperative echocardiography, patients had either no (0) or 1 + regurgitation (1 + = 98);13 (3.4%) had 2 + . Three patients (1%) required reoperation for aortic valve failure before discharge (two tailoring, one remodeling). Conclusions: Excellent early results can be achieved by aortic root preserving procedures and concurrent aortic valve leaflet repairs when appropriately selected for a diverse class of pathologies.