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Christopher M Feindel - One of the best experts on this subject based on the ideXlab platform.

  • repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm
    The Journal of Thoracic and Cardiovascular Surgery, 1995
    Co-Authors: Tirone E David, Christopher M Feindel, Joanne Bos
    Abstract:

    Patients with aneurysms of the ascending aorta or aortic root frequently have aortic insufficiency despite normal aortic leaflets. The aortic valve dysfunction is caused by dilatation of the sinotubular junction, distortion or dilatation of the sinuses of Valsalva, Annuloaortic Ectasia, or a combination of these problems. In the case of Annuloaortic Ectasia, reconstruction of the aortic root is performed by reimplanting the aortic valve in a tubular Dacron graft (reimplantation). In the case of mild or no Annuloaortic Ectasia, reconstruction of the aortic root is performed by correcting the dilated sinotubular junction and replacement of the aortic sinuses if they are also dilated with an appropriately tailored Dacron graft (remodeling). From July 1989 to March 1994, 45 patients have had either reimplantation of the aortic valve (19 patients) or remodeling of the aortic root (26 patients). Fourteen patients had Marfan's syndrome, 11 had acute and five had chronic type A aortic dissection, and nine also had transverse arch aneurysm. There were two operative deaths, both in the remodeling group. One patient who had reimplantation needed composite replacement of the aortic valve and ascending aorta because of persistent aortic insufficiency after the repair. A young patient with Marfan's syndrome had progressive aortic valve dysfunction during a growth spurt and had aortic valve replacement 2 years after the initial operation. No other valve-related complication has occurred. The remaining 41 patients have only mild or no aortic insufficiency, and the repair remains stable from 1 to 58 months, mean 18 months. These two types of aortic valve reconstruction have provided excellent clinical results in carefully selected adult patients.

  • an aortic valve sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta
    The Journal of Thoracic and Cardiovascular Surgery, 1992
    Co-Authors: Tirone E David, Christopher M Feindel
    Abstract:

    A number of patients who require an operation for complications of Annuloaortic Ectasia, such as aortic incompetence or aneurysm of the aortic root (or both), have normal aortic valve leaflets. We have treated these patients by excising the aneurysmal portion of the ascending aorta and sinuses of Valsalva but by leaving the aortic valve leaflets and some arterial wall attached to the left ventricular outflow tract. The aortic valve is reimplanted inside a collagen-impregnated tubular Dacron graft, similar to what is done for implantation of an aortic valve homograft. The coronary arteries are also reimplanted. This operation was performed in 10 patients. All patients had Annuloaortic Ectasia and five had the stigmata of Marfan syndrome. Four patients had acute aortic dissection. There were no operative deaths, but one patient required composite replacement of the aortic valve and ascending aorta because of persistent aortic incompetence. Postoperative Doppler echocardiography revealed normal aortic valve function in six patients and mild incompetence in three. The preliminary results of this new operation are encouraging. Further investigation is necessary to establish the best size, shape, and type of material that should be used to replace the aortic root while preserving the aortic valve.

Roberto Di Bartolomeo - One of the best experts on this subject based on the ideXlab platform.

  • composite valve graft implantation for the treatment of aortic valve and root disease results in 1045 patients
    The Journal of Thoracic and Cardiovascular Surgery, 2016
    Co-Authors: Luca Di Marco, Davide Pacini, Antonio Pantaleo, Alessandro Leone, Giuseppe Barberio, Giuseppe Marinelli, Roberto Di Bartolomeo
    Abstract:

    Abstract Objectives Aortic root replacement using a composite graft is the treatment of choice for a large variety of aortic root conditions with a diseased aortic valve. The objective of the current study was to evaluate the long-term results of this procedure. Methods Between 1978 and 2010, 1045 patients aged 58.7 ± 13.6 years underwent aortic root composite graft replacement using the following techniques: 95 Bentall operation; 926 the "button technique;" 24 the Cabrol technique. A mechanical composite valve graft was implanted in 69.6% of the patients. Six-hundred and thirty-five patients (62.3%) had Annuloaortic Ectasia and 162 (15.5%) had aortic dissection. Results Early mortality was 5.3% (55/1045). Independent risk factors for early mortality at logistic regression analysis were age ≥70 years ( P  = .051; odds ratio [OR], 2.97), New York Heart Association III-IV ( P  = .052; OR, 1.88), reoperation ( P  = .021; OR, 2.36), urgency/emergency ( P  = .003; OR, 3.09), mitral valve replacement ( P  = .001; OR, 6.01), or coronary artery bypass grafting (CABG) ( P P  = .013; OR, 0.21), and time of operation 2001-2011 ( P  = .025; OR, 0.60) were protective predictors for early mortality. Overall survival at 5, 10, and 20 years was 84.1% ± 1.3%, 65.5% ± 2.6%, and 40.7% ± 4.6%, respectively. Multivariate analysis revealed chronic renal insufficiency ( P  = .001; hazard ratio [HR], 3.48), chronic obstructive pulmonary disease ( P  = .027; HR, 1.94), aortic dissection ( P  = .001; HR, 2.63), Cabrol technique ( P  = .009; HR, 15.34), and CABG ( P  = .016; HR, 2.02) to be significant predictors of late death, and BAV ( P  = .010; HR, 0.43) to be a significant protective predictor. Freedom from thromboembolism, bleeding complications, and endocarditis was 93.7% ± 2.6%, 90.3% ± 3.1%, and 98.4% ± 1% at 20 years, respectively. Freedom from aortic reoperation was 91.8% ± 2.1% at 20 years and was significantly lower in patients with aortic dissection. Conclusions Within the limitations of this retrospective study, we can conclude that aortic root replacement for aortic root aneurysms can be performed with low morbidity and mortality and with satisfactory long-term results. Few late serious complications were related to the need for long-term anticoagulation or a prosthetic valve. Reoperation on the proximal or in the distal aorta was most commonly performed in patients with aortic dissection.

  • aortic root replacement with composite valve graft
    The Annals of Thoracic Surgery, 2003
    Co-Authors: Davide Pacini, Federico Ranocchi, Emanuela Angeli, Fabrizio Settepani, Marco Pagliaro, Sofia Martinsuarez, Roberto Di Bartolomeo, Angelo Pierangeli
    Abstract:

    Abstract Background Composite valve graft replacement is currently the treatment of choice for a wide variety of lesions of the aortic root and the ascending aorta. In this study we report our experience with aortic root replacement using a composite graft. Methods Between October 1978 and May 2001, 274 patients (79.6% male and 20.4% female) with a mean age of 53.5 years underwent composite graft replacement of the aortic root. One hundred sixty-one patients (70.8%) had Annuloaortic Ectasia and 46 (16.8%) aortic dissection. The classic Bentall technique was used in 94 patients (34.3%), the "button technique" in 172 patients (62.8%), and the Cabrol technique in 8 patients (2.9%). Results The early mortality rate was 6.9% (19 of 274 patients). Cardiopulmonary bypass time longer than 180 minutes and associated coronary artery bypass grafting were found to be independent risk factors of early mortality. The actuarial survival rate was 77.7% at 5 years and 63% at 10 years. The independent risk factors for late mortality were coronary artery disease, chronic renal failure, and postoperative dialysis. The actuarial freedom from reoperation on the remaining aorta was higher among patients without Marfan syndrome (94.6% versus 79.6% at 10 years, p = 0.008). Conclusions Composite valve graft replacement can be performed with low hospital mortality and morbidity. The button technique offers some advantages and should be used whenever possible. In case of acute aortic dissection root replacement is usually not necessary. Marfan patients should be treated with early root replacement before dissection occurs.

Tirone E David - One of the best experts on this subject based on the ideXlab platform.

  • repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm
    The Journal of Thoracic and Cardiovascular Surgery, 1995
    Co-Authors: Tirone E David, Christopher M Feindel, Joanne Bos
    Abstract:

    Patients with aneurysms of the ascending aorta or aortic root frequently have aortic insufficiency despite normal aortic leaflets. The aortic valve dysfunction is caused by dilatation of the sinotubular junction, distortion or dilatation of the sinuses of Valsalva, Annuloaortic Ectasia, or a combination of these problems. In the case of Annuloaortic Ectasia, reconstruction of the aortic root is performed by reimplanting the aortic valve in a tubular Dacron graft (reimplantation). In the case of mild or no Annuloaortic Ectasia, reconstruction of the aortic root is performed by correcting the dilated sinotubular junction and replacement of the aortic sinuses if they are also dilated with an appropriately tailored Dacron graft (remodeling). From July 1989 to March 1994, 45 patients have had either reimplantation of the aortic valve (19 patients) or remodeling of the aortic root (26 patients). Fourteen patients had Marfan's syndrome, 11 had acute and five had chronic type A aortic dissection, and nine also had transverse arch aneurysm. There were two operative deaths, both in the remodeling group. One patient who had reimplantation needed composite replacement of the aortic valve and ascending aorta because of persistent aortic insufficiency after the repair. A young patient with Marfan's syndrome had progressive aortic valve dysfunction during a growth spurt and had aortic valve replacement 2 years after the initial operation. No other valve-related complication has occurred. The remaining 41 patients have only mild or no aortic insufficiency, and the repair remains stable from 1 to 58 months, mean 18 months. These two types of aortic valve reconstruction have provided excellent clinical results in carefully selected adult patients.

  • an aortic valve sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta
    The Journal of Thoracic and Cardiovascular Surgery, 1992
    Co-Authors: Tirone E David, Christopher M Feindel
    Abstract:

    A number of patients who require an operation for complications of Annuloaortic Ectasia, such as aortic incompetence or aneurysm of the aortic root (or both), have normal aortic valve leaflets. We have treated these patients by excising the aneurysmal portion of the ascending aorta and sinuses of Valsalva but by leaving the aortic valve leaflets and some arterial wall attached to the left ventricular outflow tract. The aortic valve is reimplanted inside a collagen-impregnated tubular Dacron graft, similar to what is done for implantation of an aortic valve homograft. The coronary arteries are also reimplanted. This operation was performed in 10 patients. All patients had Annuloaortic Ectasia and five had the stigmata of Marfan syndrome. Four patients had acute aortic dissection. There were no operative deaths, but one patient required composite replacement of the aortic valve and ascending aorta because of persistent aortic incompetence. Postoperative Doppler echocardiography revealed normal aortic valve function in six patients and mild incompetence in three. The preliminary results of this new operation are encouraging. Further investigation is necessary to establish the best size, shape, and type of material that should be used to replace the aortic root while preserving the aortic valve.

Davide Pacini - One of the best experts on this subject based on the ideXlab platform.

  • composite valve graft implantation for the treatment of aortic valve and root disease results in 1045 patients
    The Journal of Thoracic and Cardiovascular Surgery, 2016
    Co-Authors: Luca Di Marco, Davide Pacini, Antonio Pantaleo, Alessandro Leone, Giuseppe Barberio, Giuseppe Marinelli, Roberto Di Bartolomeo
    Abstract:

    Abstract Objectives Aortic root replacement using a composite graft is the treatment of choice for a large variety of aortic root conditions with a diseased aortic valve. The objective of the current study was to evaluate the long-term results of this procedure. Methods Between 1978 and 2010, 1045 patients aged 58.7 ± 13.6 years underwent aortic root composite graft replacement using the following techniques: 95 Bentall operation; 926 the "button technique;" 24 the Cabrol technique. A mechanical composite valve graft was implanted in 69.6% of the patients. Six-hundred and thirty-five patients (62.3%) had Annuloaortic Ectasia and 162 (15.5%) had aortic dissection. Results Early mortality was 5.3% (55/1045). Independent risk factors for early mortality at logistic regression analysis were age ≥70 years ( P  = .051; odds ratio [OR], 2.97), New York Heart Association III-IV ( P  = .052; OR, 1.88), reoperation ( P  = .021; OR, 2.36), urgency/emergency ( P  = .003; OR, 3.09), mitral valve replacement ( P  = .001; OR, 6.01), or coronary artery bypass grafting (CABG) ( P P  = .013; OR, 0.21), and time of operation 2001-2011 ( P  = .025; OR, 0.60) were protective predictors for early mortality. Overall survival at 5, 10, and 20 years was 84.1% ± 1.3%, 65.5% ± 2.6%, and 40.7% ± 4.6%, respectively. Multivariate analysis revealed chronic renal insufficiency ( P  = .001; hazard ratio [HR], 3.48), chronic obstructive pulmonary disease ( P  = .027; HR, 1.94), aortic dissection ( P  = .001; HR, 2.63), Cabrol technique ( P  = .009; HR, 15.34), and CABG ( P  = .016; HR, 2.02) to be significant predictors of late death, and BAV ( P  = .010; HR, 0.43) to be a significant protective predictor. Freedom from thromboembolism, bleeding complications, and endocarditis was 93.7% ± 2.6%, 90.3% ± 3.1%, and 98.4% ± 1% at 20 years, respectively. Freedom from aortic reoperation was 91.8% ± 2.1% at 20 years and was significantly lower in patients with aortic dissection. Conclusions Within the limitations of this retrospective study, we can conclude that aortic root replacement for aortic root aneurysms can be performed with low morbidity and mortality and with satisfactory long-term results. Few late serious complications were related to the need for long-term anticoagulation or a prosthetic valve. Reoperation on the proximal or in the distal aorta was most commonly performed in patients with aortic dissection.

  • aortic root replacement with composite valve graft
    The Annals of Thoracic Surgery, 2003
    Co-Authors: Davide Pacini, Federico Ranocchi, Emanuela Angeli, Fabrizio Settepani, Marco Pagliaro, Sofia Martinsuarez, Roberto Di Bartolomeo, Angelo Pierangeli
    Abstract:

    Abstract Background Composite valve graft replacement is currently the treatment of choice for a wide variety of lesions of the aortic root and the ascending aorta. In this study we report our experience with aortic root replacement using a composite graft. Methods Between October 1978 and May 2001, 274 patients (79.6% male and 20.4% female) with a mean age of 53.5 years underwent composite graft replacement of the aortic root. One hundred sixty-one patients (70.8%) had Annuloaortic Ectasia and 46 (16.8%) aortic dissection. The classic Bentall technique was used in 94 patients (34.3%), the "button technique" in 172 patients (62.8%), and the Cabrol technique in 8 patients (2.9%). Results The early mortality rate was 6.9% (19 of 274 patients). Cardiopulmonary bypass time longer than 180 minutes and associated coronary artery bypass grafting were found to be independent risk factors of early mortality. The actuarial survival rate was 77.7% at 5 years and 63% at 10 years. The independent risk factors for late mortality were coronary artery disease, chronic renal failure, and postoperative dialysis. The actuarial freedom from reoperation on the remaining aorta was higher among patients without Marfan syndrome (94.6% versus 79.6% at 10 years, p = 0.008). Conclusions Composite valve graft replacement can be performed with low hospital mortality and morbidity. The button technique offers some advantages and should be used whenever possible. In case of acute aortic dissection root replacement is usually not necessary. Marfan patients should be treated with early root replacement before dissection occurs.

Andrezej W. Sosnowski - One of the best experts on this subject based on the ideXlab platform.

  • replacement of the ascending aorta aortic root and valve with a novel stentless valved conduit
    The Annals of Thoracic Surgery, 2008
    Co-Authors: Krystyna Bochenekklimczyk, Manuel Galinanes, Andrezej W. Sosnowski
    Abstract:

    Purpose. Biologic valved-conduit grafts avoid the need for anticoagulation and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of sinuses of Valsalva into the neoaortic root can improve the function of the stentless valves. Description. Here we present a novel prefabricated stentless valved conduit incorporating sinuses of Valsalva and describe the technique of implantation. The BioValsalva (Vascutek Terumo, Renfrewshire, Scotland) valved conduit incorporates a stentless porcine aortic valve (Elan; Vascutek Terumo) suspended within a triple-layered vascular conduit (Triplex; Vascutek Terumo) constructed with sinuses of Valsalva. Evaluation. The BioValsalva valved conduit was used in 12 patients with aortic regurgitation due to Annuloaortic Ectasia unsuitable for aortic valve repair and concomitant ascending aorta aneurysm, with no deaths and excellent functioned result. Conclusions. The prefabricated, composite, stentless valved conduit is composed of material that is hemostatic and reduces bleeding. It is easy to implant, with a short ischemic time, and lends itself well to a variety of insertion techniques.

  • Replacement of the Ascending Aorta, Aortic Root and Valve with a Novel Stentless Valved-Conduit
    2008
    Co-Authors: Kelvin K. W. Lau, Manuel Galinanes, Krystyna Bochenek-klimczyk, Andrezej W. Sosnowski
    Abstract:

    Purpose:- Biological valved-conduit grafts avoid the need for anticoagulation, and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of sinuses of Valsalva into the neoaortic root can improve the function of the stentless valves. Description:- Here we present a novel prefabricated stentless valved-conduit incorporating sinuses of Valsalva and describe the technique of inplantation. The BioValsalva™ valved-conduit incorporates a stentless porcine aortic valve (Vascutek Elan™) suspended within a triple-layered vascular conduit (Triplex™, Vascutek, Renfrewshire, Scotland) constructed with sinuses of Valsalva. Evaluation:- The BioValsalva™ valve-conduit was used in twelve patients with aortic regurgitation due to Annuloaortic Ectasia unsuitable for aortic valve repair and concomitant ascending aorta aneurysm with no mortality and excellent functioned result. Conclusion:- The prefabricated, composite stentless-valved-conduit, which material is hemostatic and reduces bleeding, is easy to implant with short ischemic time, and lends itself well to a variety of insertion techniques