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Tirone E David - One of the best experts on this subject based on the ideXlab platform.
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aortic valve sparing operations in patients with aneurysms of the aortic root or Ascending Aorta
The Annals of Thoracic Surgery, 2002Co-Authors: Tirone E David, Joan Ivanov, Susan Armstrong, Christopher M Feindel, Gary D WebbAbstract:Abstract Background Aortic valve-sparing operations are an alternative to aortic root replacement in patients with aortic root aneurysms, or aortic valve replacement and supracoronary replacement of the Ascending Aorta in patients with Ascending Aorta aneurysms and dilated sinotubular junctions with consequent aortic insufficiency. Methods From 1988 to 2001, 230 patients underwent aortic valve-sparing operations for aortic root aneurysms (151 patients) or Ascending aortic aneurysms with aortic insufficiency (79 patients). Two types of aortic valve-sparing operations were performed in patients with aortic root aneurysms: reimplantation of the aortic valve and remodeling of the aortic root. Mean follow-up was 3.8 ± 2.8 years. Results Patients with aortic root aneurysms were younger, had less severe aortic insufficiency, less extensive vascular disease, and better left ventricular function than patients with Ascending Aorta aneurysms. The 8-year survival was 83% ± 5% for the first group and 36% ± 14% for the second. The freedom from aortic valve reoperation at 8 years was 99% ± 1% for the first group and 97% ± 2% for the second. In patients who had aortic root aneurysms, 3 developed severe aortic insufficiency (AI), and 15 developed moderate AI, for an 8-year freedom from significant AI of 67% ± 7%. But freedom from AI was 90% ± 3% after the technique of reimplantation, and 55% ± 6% after the technique of remodeling ( p = 0.02). In patients with Ascending aortic aneurysms, the freedom from AI greater than 2+ at 8 years was 67% ± 11%. Conclusions The long-term results of aortic valve sparing for aortic root aneurysms are excellent, and reimplantation of the aortic valve may provide a more stable repair of the aortic valve than remodeling of the aortic root.
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histologic abnormalities of the Ascending Aorta and pulmonary trunk in patients with bicuspid aortic valve disease clinical relevance to the ross procedure
The Journal of Thoracic and Cardiovascular Surgery, 1999Co-Authors: Yaron Moshkovitz, Jagdish Butany, Tirone E DavidAbstract:Abstract Objective: Bicuspid aortic valve disease is often associated with dilation of the aortic root and Ascending Aorta. This study examines the histologic features of the Ascending Aorta and main pulmonary artery of patients with and without aortic valve disease. Methods: Samples from Ascending Aorta and main pulmonary artery were obtained at the time of the operation from 20 patients with bicuspid aortic valve and 11 patients with tricuspid aortic valve disease. In addition, samples were also obtained from autopsy cases with normal aortic valve. The histologic changes were graded from 1 to 3 according to severity of degenerative changes. Results: In the Ascending Aorta, the severity of cystic medial necrosis ( P = .001), elastic fragmentation ( P = .002), and changes in the smooth muscle cell orientation ( P = .002) were significantly more severe in patients with bicuspid than in those with tricuspid aortic valve disease. In the pulmonary trunk specimens, those 3 histologic features were also significantly more severe in patients with bicuspid than those with tricuspid valves ( P = .001, P = .01, and P = .04, respectively). Seventy-five percent of patients with bicuspid aortic valve disease had grade 3 degenerative changes, whereas only 14% of those patients with tricuspid aortic valve disease had similar degrees of degenerative changes. Conclusion: Patients with bicuspid aortic valve disease have more severe degenerative changes in the media of the Ascending Aorta and main pulmonary artery than patients with tricuspid aortic valve disease. These findings may explain root and Ascending aortic dilation in patients with bicuspid aortic valve disease and pulmonary autograft dilation in certain patients after the Ross procedure. (J Thorac Cardiovasc Surg 1999;118:588-96)
Roland Hetzer - One of the best experts on this subject based on the ideXlab platform.
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configuration of the Ascending Aorta in patients with bicuspid and tricuspid aortic valve disease undergoing aortic valve replacement with or without reduction aortoplasty
Journal of Heart Valve Disease, 2006Co-Authors: Matthias Bauer, Henryk Siniawski, Volker Gliech, Roland HetzerAbstract:BACKGROUND AND AIM OF THE STUDY: Patients with bicuspid aortic valves (BAV) tend to develop dilatation of the Ascending Aorta. The study aim was to analyze differences in aortic root diameter and configuration in patients with bicuspid and tricuspid aortic valve disease. METHODS: A retrospective analysis was conducted of the angiographies of 461 patients allocated to four groups with: (i) BAV disease with (n = 179) and (ii) without (n = 78) dilatation of the Ascending Aorta; (iii) tricuspid aortic valve disease (TAV) and dilatation of the Ascending Aorta (n = 154); and (iv) coronary artery disease (CAD), TAV and normal diameter of the Ascending Aorta (n=50). Diameters and distances in the aortic root region were measured, and the Ascending Aorta configuration analyzed. RESULTS: The diameter of the Ascending Aorta in patients with BAV and dilatation was significantly larger than in those with TAV and dilatation (26.6 +/- 5.22 versus 24.4 +/- 3.74 mm/m2, p = 0.002). Distances between aortic valve level and point of maximum diameter of the Ascending Aorta at the outer and inner curve of the vessel in patients with BAV without dilatation were greater than those of the CAD group (31.1 +/- 5.27 versus 28.0 +/- 4.86 mm/m2, p = 0.002 and for the indexed values 21.6 +/- 4.05 versus 20.0 +/- 2.71 mm/m2, p = 0.011). All patients with BAV and enlargement of the Ascending Aorta showed asymmetric dilatation of the vessel. CONCLUSION: All patients with BAV had an abnormal configuration of the Ascending Aorta. In cases with enlargement of the Ascending Aorta exclusively, asymmetric dilatation at the convexity of the vessel occurred. Patients with BAV and normal Ascending Aorta diameter showed an elongation of this vessel segment.
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different hemodynamic stress of the Ascending Aorta wall in patients with bicuspid and tricuspid aortic valve
Journal of Cardiac Surgery, 2006Co-Authors: Matthias Bauer, M Pasic, Henryk Siniawski, Beate Schaumann, Roland HetzerAbstract:It is unclear whether Ascending Aorta dilation in patients with bicuspid aortic valve is caused by abnormal hemodynamics or by a common developmental defect of the aortic valve and aortic wall. We performed an echocardiographic study to examine the differences in hemodynamic stress at the Ascending Aorta in patients with bicuspid and tricuspid aortic valve. We studied prospectively 58 consecutive patients referred for preoperative echocardiographic examination with aortic valve stenosis and either bicuspid or tricuspid valve and an Ascending aortic diameter of Ascending Aorta. The tissue Doppler examination showed a significantly higher peak systolic wall velocity of the anterolateral region of the Ascending Aorta in patients with bicuspid aortic valve (12.2 +/- 4.3 cm/sec vs. 8.8 +/- 2.6 cm/sec, p = 0.047). We conclude that in patients with bicuspid aortic valve and aortic valve stenosis the anterolateral region of the Ascending Aorta is subject to greater hemodynamic stress than in patients with tricuspid aortic valve.
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reduction aortoplasty for dilatation of the Ascending Aorta in patients with bicuspid aortic valve
The Annals of Thoracic Surgery, 2002Co-Authors: Matthias Bauer, M Pasic, Raymond Schaffarzyk, Henryk Siniawski, Friedrich D Knollmann, Rudolf Meyer, Roland HetzerAbstract:Abstract Background . Individuals with bicuspid aortic valve tend to develop a dilatation of the Ascending Aorta. It is controversial whether the dilated Ascending Aorta should be replaced with a tube graft or whether the diameter of the Aorta should be reduced by reduction aortoplasty. Furthermore, it is unclear whether an external prosthetic support of the reduction aortoplasty is necessary. The aim of this study is to analyze the results of reduction aortoplasty with and without external prosthetic support. Methods . Between 1985 and 1999, a total of 115 patients with bicuspid aortic valve and dilatation of the Ascending Aorta underwent reduction aortoplasty in combination with other types of open-heart procedure at our institution. The diameter of the Ascending Aorta was measured before and early after surgery and then later between 12 and 144 months (mean 40 months) postoperatively using echocardiography and computed tomography. Results . The reduction aortoplasty decreased the internal diameter of the Aorta from 48.7 ± 5.1 mm preoperatively to 36.9 ± 3.6 mm early after surgery ( p = 0.0001). During follow-up, there was no increase of the aortic diameter either in patients with external prosthetic support or in 97 of 106 patients without external prosthetic support. The diameter increased only in 9 (8.5%) of 106 patients without external aortic support by 4 to 8 mm. In patients with postoperative diameter increase, the aortic diameter after operation had been higher than in patients without a postoperative increase of the aortic diameter (41.4 ± 3.1 mm vs 36.6 ± 3.4 mm; p Conclusion . Reduction aortoplasty showed good long-term results in patients with bicuspid aortic valve and dilatation of the Ascending Aorta. Redilation of the Aorta occurred only in patients with a suboptimal diameter reduction.
Piroze Davierwala - One of the best experts on this subject based on the ideXlab platform.
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should the Ascending Aorta be replaced more frequently in patients with bicuspid aortic valve disease
The Journal of Thoracic and Cardiovascular Surgery, 2004Co-Authors: Joan Ivanov, Michael A Borger, Mark A Preston, Paul W M Fedak, Piroze DavierwalaAbstract:Objective The optimal diameter at which replacement of the Ascending Aorta should be performed in patients with bicuspid aortic valve disease is not known. Methods We reviewed all patients with bicuspid aortic valves undergoing aortic valve replacement at our institution from 1979 through 1993 (n = 201). Patients undergoing concomitant replacement of the Ascending Aorta were excluded. Results Follow-up was obtained on 98% of patients and was 10.3 ± 3.8 (mean ± SD) years. The average patient age was 56 ± 15 years, and 76% were male. The Ascending Aorta was normal ( 5.0 cm) underwent replacement of the Ascending Aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patients required reoperation, predominantly for aortic valve prosthesis failure. Twenty-two patients had long-term complications related to the Ascending Aorta: 18 required an operative procedure to replace the Ascending Aorta (for aortic aneurysm), 1 had aortic dissection, and 3 experienced sudden cardiac death. Fifteen-year freedom from Ascending Aorta–related complications was 86%, 81%, and 43% in patients with an aortic diameter of less than 4.0 cm, 4.0 to 4.4 cm, and 4.5 to 4.9 cm, respectively ( P Conclusions Patients undergoing operations for bicuspid aortic valve disease should be considered for concomitant replacement of the Ascending Aorta if the diameter is 4.5 cm or greater.
Joan Ivanov - One of the best experts on this subject based on the ideXlab platform.
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should the Ascending Aorta be replaced more frequently in patients with bicuspid aortic valve disease
The Journal of Thoracic and Cardiovascular Surgery, 2004Co-Authors: Joan Ivanov, Michael A Borger, Mark A Preston, Paul W M Fedak, Piroze DavierwalaAbstract:Objective The optimal diameter at which replacement of the Ascending Aorta should be performed in patients with bicuspid aortic valve disease is not known. Methods We reviewed all patients with bicuspid aortic valves undergoing aortic valve replacement at our institution from 1979 through 1993 (n = 201). Patients undergoing concomitant replacement of the Ascending Aorta were excluded. Results Follow-up was obtained on 98% of patients and was 10.3 ± 3.8 (mean ± SD) years. The average patient age was 56 ± 15 years, and 76% were male. The Ascending Aorta was normal ( 5.0 cm) underwent replacement of the Ascending Aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patients required reoperation, predominantly for aortic valve prosthesis failure. Twenty-two patients had long-term complications related to the Ascending Aorta: 18 required an operative procedure to replace the Ascending Aorta (for aortic aneurysm), 1 had aortic dissection, and 3 experienced sudden cardiac death. Fifteen-year freedom from Ascending Aorta–related complications was 86%, 81%, and 43% in patients with an aortic diameter of less than 4.0 cm, 4.0 to 4.4 cm, and 4.5 to 4.9 cm, respectively ( P Conclusions Patients undergoing operations for bicuspid aortic valve disease should be considered for concomitant replacement of the Ascending Aorta if the diameter is 4.5 cm or greater.
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aortic valve sparing operations in patients with aneurysms of the aortic root or Ascending Aorta
The Annals of Thoracic Surgery, 2002Co-Authors: Tirone E David, Joan Ivanov, Susan Armstrong, Christopher M Feindel, Gary D WebbAbstract:Abstract Background Aortic valve-sparing operations are an alternative to aortic root replacement in patients with aortic root aneurysms, or aortic valve replacement and supracoronary replacement of the Ascending Aorta in patients with Ascending Aorta aneurysms and dilated sinotubular junctions with consequent aortic insufficiency. Methods From 1988 to 2001, 230 patients underwent aortic valve-sparing operations for aortic root aneurysms (151 patients) or Ascending aortic aneurysms with aortic insufficiency (79 patients). Two types of aortic valve-sparing operations were performed in patients with aortic root aneurysms: reimplantation of the aortic valve and remodeling of the aortic root. Mean follow-up was 3.8 ± 2.8 years. Results Patients with aortic root aneurysms were younger, had less severe aortic insufficiency, less extensive vascular disease, and better left ventricular function than patients with Ascending Aorta aneurysms. The 8-year survival was 83% ± 5% for the first group and 36% ± 14% for the second. The freedom from aortic valve reoperation at 8 years was 99% ± 1% for the first group and 97% ± 2% for the second. In patients who had aortic root aneurysms, 3 developed severe aortic insufficiency (AI), and 15 developed moderate AI, for an 8-year freedom from significant AI of 67% ± 7%. But freedom from AI was 90% ± 3% after the technique of reimplantation, and 55% ± 6% after the technique of remodeling ( p = 0.02). In patients with Ascending aortic aneurysms, the freedom from AI greater than 2+ at 8 years was 67% ± 11%. Conclusions The long-term results of aortic valve sparing for aortic root aneurysms are excellent, and reimplantation of the aortic valve may provide a more stable repair of the aortic valve than remodeling of the aortic root.
Matthias Bauer - One of the best experts on this subject based on the ideXlab platform.
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configuration of the Ascending Aorta in patients with bicuspid and tricuspid aortic valve disease undergoing aortic valve replacement with or without reduction aortoplasty
Journal of Heart Valve Disease, 2006Co-Authors: Matthias Bauer, Henryk Siniawski, Volker Gliech, Roland HetzerAbstract:BACKGROUND AND AIM OF THE STUDY: Patients with bicuspid aortic valves (BAV) tend to develop dilatation of the Ascending Aorta. The study aim was to analyze differences in aortic root diameter and configuration in patients with bicuspid and tricuspid aortic valve disease. METHODS: A retrospective analysis was conducted of the angiographies of 461 patients allocated to four groups with: (i) BAV disease with (n = 179) and (ii) without (n = 78) dilatation of the Ascending Aorta; (iii) tricuspid aortic valve disease (TAV) and dilatation of the Ascending Aorta (n = 154); and (iv) coronary artery disease (CAD), TAV and normal diameter of the Ascending Aorta (n=50). Diameters and distances in the aortic root region were measured, and the Ascending Aorta configuration analyzed. RESULTS: The diameter of the Ascending Aorta in patients with BAV and dilatation was significantly larger than in those with TAV and dilatation (26.6 +/- 5.22 versus 24.4 +/- 3.74 mm/m2, p = 0.002). Distances between aortic valve level and point of maximum diameter of the Ascending Aorta at the outer and inner curve of the vessel in patients with BAV without dilatation were greater than those of the CAD group (31.1 +/- 5.27 versus 28.0 +/- 4.86 mm/m2, p = 0.002 and for the indexed values 21.6 +/- 4.05 versus 20.0 +/- 2.71 mm/m2, p = 0.011). All patients with BAV and enlargement of the Ascending Aorta showed asymmetric dilatation of the vessel. CONCLUSION: All patients with BAV had an abnormal configuration of the Ascending Aorta. In cases with enlargement of the Ascending Aorta exclusively, asymmetric dilatation at the convexity of the vessel occurred. Patients with BAV and normal Ascending Aorta diameter showed an elongation of this vessel segment.
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different hemodynamic stress of the Ascending Aorta wall in patients with bicuspid and tricuspid aortic valve
Journal of Cardiac Surgery, 2006Co-Authors: Matthias Bauer, M Pasic, Henryk Siniawski, Beate Schaumann, Roland HetzerAbstract:It is unclear whether Ascending Aorta dilation in patients with bicuspid aortic valve is caused by abnormal hemodynamics or by a common developmental defect of the aortic valve and aortic wall. We performed an echocardiographic study to examine the differences in hemodynamic stress at the Ascending Aorta in patients with bicuspid and tricuspid aortic valve. We studied prospectively 58 consecutive patients referred for preoperative echocardiographic examination with aortic valve stenosis and either bicuspid or tricuspid valve and an Ascending aortic diameter of Ascending Aorta. The tissue Doppler examination showed a significantly higher peak systolic wall velocity of the anterolateral region of the Ascending Aorta in patients with bicuspid aortic valve (12.2 +/- 4.3 cm/sec vs. 8.8 +/- 2.6 cm/sec, p = 0.047). We conclude that in patients with bicuspid aortic valve and aortic valve stenosis the anterolateral region of the Ascending Aorta is subject to greater hemodynamic stress than in patients with tricuspid aortic valve.
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reduction aortoplasty for dilatation of the Ascending Aorta in patients with bicuspid aortic valve
The Annals of Thoracic Surgery, 2002Co-Authors: Matthias Bauer, M Pasic, Raymond Schaffarzyk, Henryk Siniawski, Friedrich D Knollmann, Rudolf Meyer, Roland HetzerAbstract:Abstract Background . Individuals with bicuspid aortic valve tend to develop a dilatation of the Ascending Aorta. It is controversial whether the dilated Ascending Aorta should be replaced with a tube graft or whether the diameter of the Aorta should be reduced by reduction aortoplasty. Furthermore, it is unclear whether an external prosthetic support of the reduction aortoplasty is necessary. The aim of this study is to analyze the results of reduction aortoplasty with and without external prosthetic support. Methods . Between 1985 and 1999, a total of 115 patients with bicuspid aortic valve and dilatation of the Ascending Aorta underwent reduction aortoplasty in combination with other types of open-heart procedure at our institution. The diameter of the Ascending Aorta was measured before and early after surgery and then later between 12 and 144 months (mean 40 months) postoperatively using echocardiography and computed tomography. Results . The reduction aortoplasty decreased the internal diameter of the Aorta from 48.7 ± 5.1 mm preoperatively to 36.9 ± 3.6 mm early after surgery ( p = 0.0001). During follow-up, there was no increase of the aortic diameter either in patients with external prosthetic support or in 97 of 106 patients without external prosthetic support. The diameter increased only in 9 (8.5%) of 106 patients without external aortic support by 4 to 8 mm. In patients with postoperative diameter increase, the aortic diameter after operation had been higher than in patients without a postoperative increase of the aortic diameter (41.4 ± 3.1 mm vs 36.6 ± 3.4 mm; p Conclusion . Reduction aortoplasty showed good long-term results in patients with bicuspid aortic valve and dilatation of the Ascending Aorta. Redilation of the Aorta occurred only in patients with a suboptimal diameter reduction.
