| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:767-772
© 2004 The Society of Thoracic Surgeons
a Division of Cardiac Surgery, Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
b Howard Hughes Medical Institute, Chevy Chase,, USA
c Division of Pediatric Cardiology, Baltimore, MD, USA
d Division of Adult Cardiology, the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Accepted for publication March 16, 2004.
* Address reprint requests to Dr Gott, 618 Blalock Building, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA
vgott{at}csurg.jhmi.jhu.edu
Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003. *Recipient of the 2003 Hawley H. Seiler Resident Award.
BACKGROUND: Valve-sparing operations for aortic root aneurysms are increasing in frequency, but techniques and results are still in evolution. We reviewed our experience with 65 patients (adults and children) who had this operation at our institution to determine early and late outcomes.
METHODS: A retrospective clinical review was undertaken using hospital records, clinical and echocardiographic, computed tomography, magnetic resonance imaging data, and telephone interviews with patients and their physicians.
RESULTS: Between July 1994 and December 2002, 65 patients (46 adults and 19 children) underwent a valve-sparing operation for aortic root aneurysm. Forty-four of the patients had the Marfan syndrome; the remaining 21 had either a nonspecific connective tissue disorder (14 patients) or a miscellaneous disease process such as Ehlers-Danlos syndrome (7 patients). Fifty-eight (89%) had a David II (remodeling) procedure and 7 had a David I (reimplantation) procedure. The DePaulis "Valsalva graft" was used in six of the David I patients. There were no operative or hospital deaths; only one late death occurred in an adult due to salmonella meningitis. Overall, survival was 100% at one year and 98% at 3 and 5 years. Ten patients (7 adults and 3 children) developed significant late aortic insufficiency (AI). Nine of these patients had a David II procedure and in 8 of these cases, AI was secondary to significant late annular dilatation. One of the 10 patients developed late AI 8.2 years after a David I procedure; his AI was secondary to aortic leaflet extension and prolapse. Six of the 10 patients who developed significant late AI required aortic valve replacement (4 adults and 2 children). Freedom from late aortic valve replacement (AVR) in this series of 65 patients was 91% at 3 and 84% at 5 years. At the close of this study, 58 patients were New York Heart Association (NYHA) class I and 6 were NYHA class II; no patients were class III or IV. There were no episodes of endocarditis or clinically significant thromboembolism.
CONCLUSIONS: Valve-sparing operations provide satisfactory results for many patients with an aortic root aneurysm, but the David II remodeling procedure has a greater risk of late annular dilatation and AI. The David I reimplantation procedure utilizing the DePaulis Valsalva graft may obviate this problem.
This article has been cited by other articles:
|
|
 |
|
  G. D. Pearson, R. Devereux, B. Loeys, C. Maslen, D. Milewicz, R. Pyeritz, F. Ramirez, D. Rifkin, L. Sakai, L. Svensson, et al. Report of the National Heart, Lung, and Blood Institute and National Marfan Foundation Working Group on Research in Marfan Syndrome and Related Disorders Circulation, August 12, 2008; 118(7): 785 - 791. [Full Text] [PDF]
|
|
|
|
 |
|
 N. D. Patel, E. S. Weiss, D. E. Alejo, L. U. Nwakanma, J. A. Williams, H. C. Dietz, P. J. Spevak, V. L. Gott, L. A. Vricella, and D. E. Cameron Aortic root operations for marfan syndrome: a comparison of the bentall and valve-sparing procedures. Ann. Thorac. Surg., June 1, 2008; 85(6): 2003 - 2011. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ogino, K. Minatoya, H. Matsuda, and H. Sasaki Easy Technique for Placing Anchoring Sutures for Aortic Root Reimplantation Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 162 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. David Aortic Valve Repair and Aortic Valve Sparing Operations Card. Surg. Adult, January 1, 2008; 3(2008): 935 - 948. [Full Text]
|
|
|
|
|
|
A. Rama, S. Rubin, N. Bonnet, and I. Gandjbakhch New Technique of Aortic Root Reconstruction With Aortic Valve Annuloplasty in Ascending Aortic Aneurysm Ann. Thorac. Surg., May 1, 2007; 83(5): 1908 - 1910. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Lansac, I. Di Centa, F. Raoux, R. Raffoul, N. Al Attar, A. Rama, C. Acar, and P. Nataf Aortic annuloplasty: towards a standardized approach of conservative aortic valve surgery MMCTS, March 29, 2007; 2007(0329): 1958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Svensson, E. H. Blackstone, J. Feng, D. de Oliveira, A. M. Gillinov, M. Thamilarasan, R. A. Grimm, B. Griffin, D. Hammer, T. Williams, et al. Are Marfan Syndrome and Marfanoid Patients Distinguishable on Long-Term Follow-Up? Ann. Thorac. Surg., March 1, 2007; 83(3): 1067 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Miller Valve-Sparing Aortic Root Replacement: Current State of the Art and Where Are We Headed? Ann. Thorac. Surg., February 1, 2007; 83(2): S736 - S739. [Full Text] [PDF]
|
|
|
|
|
|
H. Jeanmart, L. de Kerchove, D. Glineur, J.-M. Goffinet, I. Rougui, M. Van Dyck, P. Noirhomme, and G. El Khoury Aortic Valve Repair: The Functional Approach to Leaflet Prolapse and Valve-Sparing Surgery Ann. Thorac. Surg., February 1, 2007; 83(2): S746 - S751. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Erasmi, H.-H. Sievers, J.F. M. Bechtel, T. Hanke, U. Stierle, and M. Misfeld Remodeling or Reimplantation for Valve-Sparing Aortic Root Surgery? Ann. Thorac. Surg., February 1, 2007; 83(2): S752 - S756. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Settepani, W. Y. Szeto, D. Pacini, R. De Paulis, L. Chiariello, R. Di Bartolomeo, R. Gallotti, and J. E. Bavaria Reimplantation Valve-Sparing Aortic Root Replacement in Marfan Syndrome Using the Valsalva Conduit: An Intercontinental Multicenter Study Ann. Thorac. Surg., February 1, 2007; 83(2): S769 - S773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Pacini, F. Settepani, R. De Paulis, A. Loforte, S. Nardella, D. Ornaghi, R. Gallotti, L. Chiariello, and R. Di Bartolomeo Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann. Thorac. Surg., September 1, 2006; 82(3): 865 - 871. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. D. Patel, J. A. Williams, C. J. Barreiro, B. T. Bethea, T. P. Fitton, H. C. Dietz, J. A.C. Lima, P. J. Spevak, V. L. Gott, L. A. Vricella, et al. Valve-Sparing Aortic Root Replacement: Early Experience With the De Paulis Valsalva Graft in 51 Patients Ann. Thorac. Surg., August 1, 2006; 82(2): 548 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. David, C. M. Feindel, G. D. Webb, J. M. Colman, S. Armstrong, and M. Maganti Long-term results of aortic valve-sparing operations for aortic root aneurysm. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 347 - 354. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ranga, O. Bouchot, R. Mongrain, P. Ugolini, and R. Cartier Computational simulations of the aortic valve validated by imaging data: evaluation of valve-sparing techniques Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 373 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. De Paulis, R. Scaffa, S. Forlani, and L. Chiariello The Valsalva graft in aortic valve repair and replacement MMCTS, November 29, 2005; 2005(1129): 992. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Vricella, J. A. Williams, W. J. Ravekes, K. W. Holmes, H. C. Dietz, V. L. Gott, and D. E. Cameron Early Experience With Valve-Sparing Aortic Root Replacement in Children Ann. Thorac. Surg., November 1, 2005; 80(5): 1622 - 1627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Albes, U. A. Stock, and M. Hartrumpf Restitution of the Aortic Valve: What is New, What is Proven, and What is Obsolete? Ann. Thorac. Surg., October 1, 2005; 80(4): 1540 - 1549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Erasmi, H.-H. Sievers, M. Scharfschwerdt, T. Eckel, and M. Misfeld In vitro hydrodynamics, cusp-bending deformation, and root distensibility for different types of aortic valve-sparing operations: Remodeling, sinus prosthesis, and reimplantation J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1044 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kallenbach, M. Karck, D. Pak, R. Salcher, N. Khaladj, R. Leyh, C. Hagl, and A. Haverich Decade of Aortic Valve Sparing Reimplantation: Are We Pushing the Limits Too Far? Circulation, August 30, 2005; 112(9_suppl): I-253 - I-259. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
