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Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
Aortic valve replacement or Bentall procedure, with aortic valve and graft replacement, are the indicated methods of treatment. However, aortic valve repair is preferable where feasible, in the hands of experienced surgeons. Optimal candidates for aortic valve repair are younger patients with tricuspid aortic valve, without any calcification, and type I (aortic root dilation) or II (aortic cusp prolapse) mechanism of AR. Repair usually consists of re-implantation or remodeling of the native aortic valve with annuloplasty.21 Although transcatheter aortic valve implantation is promising, limited evidence exists for AR.
Minimally Invasive Aortic Valve Replacement
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
AVR and ascending aorta (Bentall procedure) (Figures 7.2.12, 7.2.13), aortic root replacement, valve-sparing aortic root replacement (David procedure) (Figure 7.2.14) and a manubrium-limited aortic procedure can also be carried out by using the upper J mini-sternotomy approach (Figure 7.2.11, Figure 7.2.12, Figure 7.2.13 and 7.2.14).
Bicuspid aortic valve and diseases of the aorta
Published in Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček, Congenital Heart Disease in Adults, 2008
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček
Surgery is performed as composite valve graft repair or a valve-sparing procedure. Composite graft repair (modified Bentall procedure) consists of a mechanical aortic valve attached to synthetic prosthesis tube, the coronary ostia are reimplantated into the aortic graft (Figure 9.50).43a In the valve-sparing procedure, the patient’s own aortic valve is spared and the ascending aorta is replaced by a synthetic prosthesis. It is advantageous for patients with a structurally normal aortic valve and a dilated aorta. Better results are achieved if aortic root dilatation is <50mm. Two approaches exist: reimplantation of the patient’s own valve into the prosthetic tube according David (Figures 9.51–9.55), or the remodeling technique according Yacoub.43–45 The operative mortality of the valve-sparing procedure is low, and valverelated 5–10 year morbidity and mortality are superior to those of composite graft repair.46,47 The great advantage of the valve-sparing procedure is a lower risk of IE and thromboembolism, and avoidance of lifelong anticoagulation therapy.
Comparison of the Bentall procedure versus valve-sparing aortic root replacement
Published in Baylor University Medical Center Proceedings, 2020
Mohanad Hamandi, C. Ikenna Nwafor, Ronald Baxter, Kathryn Shinn, Jordan Wooley, Anupama Vasudevan, Katherine Harrington, Justin Schaffer, David Moore, J. Michael DiMaio, William H. Ryan, William T. Brinkman
For patients with various aortic root pathologies, the composite graft procedure presented by Bentall and DeBono has been the gold standard.1 Given technological and surgical advancements over the past several decades, the procedure is performed widely with low operative risk and good clinical outcomes. Although the Bentall procedure has been successful, associated factors including systemic thromboembolic events, need for lifelong anticoagulation, endocarditis, and gradual degeneration of bioprosthetic valves make it a less desirable choice.6 This is particularly true for younger patients who will presumably have a longer postoperative lifespan. Valve-sparing aortic root procedures, originally introduced by David and Fiendel2 and Sarsan and Yacoub,3 are a viable alternative to the traditional Bentall procedure and have increased in use over the last few decades for patients with near-normal cusp structure.7,8 By maintaining the native valve, VSRR reduces the associated morbidities of the classic Bentall procedure, which has led to its increased adoption, particularly with younger patients.6,9
Porcine Aortic Root Replacement in Acute Aortic Dissection
Published in Structural Heart, 2019
Abinash Panda, Ahmed M. Osman, Ricky Vaja, Michael O. Murphy, Jullien Gaer, John Pepper, Ulrich Rosendahl, Georgios Asimakopoulos
Results: Out of the 49 patients who underwent ARR, 22 had Porcine ARR (10 females, 12 males) while 27 underwent a Bentall Operation (8 females, 19 males). Demographic & clinical characteristics of both groups were summarised in the image below. Demographic, intra- and post-operative features were similar in both groups (P>0.05) except for a statistically significant (p=0.001) difference in age between both groups. At a median follow up of 44.3 months, the freedom from re-operation on the aortic root was 94.7% and 96.4% for Porcine ARR and Bentall procedure respectively with two mid-term deaths (at 6 and 15 months post op) in the latter group. At last interrogation, all patients had freedom from greater than mild aortic incompetence and no patient in the Porcine ARR group was on long-term anticoagulants.
Double right coronary artery: a plea for a standardized nomenclature
Published in Acta Chirurgica Belgica, 2022
Sotirios D. Moraitis, Apostolos C. Agrafiotis, Panagiotis Strempelas, Georgios Kagialaris, Pantelis Tsipas
A 37-year-old male patient was admitted due to aortic root (5.1 cm) and ascending aorta (5.5 cm) aneurysm, combined with bicuspid aortic valve regurgitation. Preoperative coronary angiography and chest computed tomography with contrast material, didn’t reveal any other obvious anatomic anomaly (Figure 2(a,b)). Patient’s consent was obtained for a Bentall procedure (Euroscore I: 4.66%, Euroscore II: 1.64%). Through a median sternotomy, the pericardium was opened, an arterial cannula was placed in the proximal aortic arch, a two-stage venous cannula in the right atrium and a retrograde cardioplegia catheter into the coronary sinus. Cardiopulmonary bypass was established, a left ventricular vent catheter was inserted through the right superior pulmonary vein, aorta was cross clamped and Bretschneider (Custodiol ®) cardioplegic solution was administrated. A transverse aortotomy was performed 2 cm above the ostia of coronaries. A double ostium of the RCA was encountered (Figure 2(c)). The extremely thin cusps of the bicuspid regurgitated valve were removed, the aneurysmal ascending aorta was detached, the ‘buttons’ of the ostia were prepared and a Carbomedics Carbo-seal Valsalva graft (Valve size 27 mm, Graft Ø 30 mm) was anastomosed. The ‘buttons’ of the ostia were re-implanted to the graft. Teflon felt was used in both, proximal and distal, anastomoses (Figure 2(d)). Patient had an uneventful weaning from cardiopulmonary bypass. Postoperatively, patient suffered an episode of supraventricular tachycardia treated with amiodarone and adenosine. Chest computed tomography and cardiac ultrasound, didn’t reveal significant pericardial effusion or any anastomotic leaks. The patient was discharged on postoperative day 10.