Vol. 20 No. 2 (2016)
RECONSTRUCTIVE SURGERY OF THE AORTIC ROOT

Choosing aortic valve plasty for aortic root/ascending aorta repair

PDF (Русский)
  • E. Charchyan,
  • Yu. Belov,
  • A. Skvortsov,
  • G. Slagaev,
  • P. Shvedov
E. Charchyan
Academician B.V. Petrovskogo Russian National Centre of Surgery, 2 Abrikosovskii lane, 119991 Moscow, Russian Federation
Yu. Belov
Academician B.V. Petrovskogo Russian National Centre of Surgery, 2 Abrikosovskii lane, 119991 Moscow, Russian Federation
A. Skvortsov
Academician B.V. Petrovskogo Russian National Centre of Surgery, 2 Abrikosovskii lane, 119991 Moscow, Russian Federation
G. Slagaev
Academician B.V. Petrovskogo Russian National Centre of Surgery, 2 Abrikosovskii lane, 119991 Moscow, Russian Federation
P. Shvedov
Academician B.V. Petrovskogo Russian National Centre of Surgery, 2 Abrikosovskii lane, 119991 Moscow, Russian Federation
Bio
DOI: https://doi.org/10.21688/1681-3472-2016-2-26-34

Published 2016-08-17

Keywords

  • aortic surgery,
  • aortic valve,
  • valve-sparing operations,
  • David procedure.

How to Cite

Charchyan, E., Belov, Y., Skvortsov, A., Slagaev, G., & Shvedov, P. (2016). Choosing aortic valve plasty for aortic root/ascending aorta repair. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(2), 26–34. https://doi.org/10.21688/1681-3472-2016-2-26-34

Copyright (c) 2016 Charchyan E.R., Belov Yu.V., Skvortsov A.A., Slagaev G.I., Shvedov P.N.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim: The study was designed to evaluate the outcomes of aortic valve reimplantation (David procedure), as well as various techniques of aortic root reconstruction.
Methods: The results of 84 valve-sparing operations for thoracic aortic aneurysms and dissections were analyzed at B. Petrovsky Russian Research Center of Surgery over a period from 2007 to 2016. The first group (n = 42) consisted of patients after David procedure, the second group (n = 38) included patients after different methods of aortic root repair (fixation of commissures, leaflets plication, sinotubular ridge repair). 5-year results of surgical treatment were assessed.
Results: David procedure is characterized by good long-term results. There was no in-hospital and 5-year mortality in the first group, while 2 (5.3%) patients in the second group died in the early postoperative period. In both groups the reoperation rate was 2.4% and 8.3% respectively.
Conclusion: Valve-sparing aortic root repair is characterized by good survival rate, high freedom from reoperation and low incidence of complications.

PDF (Русский)

References

  1. Saczkowski R., Malas T., de Kerchove L., El Khoury G., Boodhwani M. Systematic review of aortic valve preservation and repair // Ann. Cardiothorac. Surg. 2013. Vol. 2 (1). P. 3–9. DOI: 10.3978/j.issn.2225-319X.2013.01.07.
  2. Pibarot P., Dumesnil J.G. Prosthetic Heart Valves: Selection of the Optimal Prosthesis and Long-Term Management // Circulation. 2009. Vol. 119 (7). P. 1034–48. DOI: 10.1161/CIRCULATIONAHA.108.778886.
  3. Aicher D., Fries R., Rodionycheva S., Schmidt K., Langer F., Schäfers H.J. Aortic valve repair leads to a low incidence of valve-related complications // Eur. J. Cardiothorac. Surg. 2010. Vol. 37 (1). P. 127–32. DOI: 10.1016/j.ejcts.2009.06.021.
  4. David T.E., Feindel C.M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta // J. Thorac. Cardiovasc. Surg. 1992. Vol. 103 (4). P. 617–621.
  5. David T.E., Feindel C.M., Webb G.D., Colman J.M., Armstrong S., Maganti M. Aortic valve preservation in patients with aortic root aneurysm: results of the reimplantation technique // Ann. Thorac. Surg. 2007. Vol. 83 (2). P. S732–735.
  6. David T.E., Armstrong S., Ivanov J., Feindel C.M., Omran A., Webb G. Results of aortic valve-sparing operations // J. Thorac. Cardiovasc. Surg. 2001. Vol. 122 (1). P. 39–46.
  7. Urbanski P.P, Hijazi H., Dinstak W., Diegeler A. Valve-sparing aortic root repair in acute type A dissection: how many sinuses have to be repaired for curative surgery? // Eur. J. Cardiothorac. Surg. 2013. Vol. 44 (3). P. 439–43. DOI: 10.1093/ejcts/ezt042.
  8. Белов Ю.В., Чарчян Э.Р. Аневризмы восходящей аорты с аортальной недостаточностью. Дис. … канд. мед. наук. М., 2006.
  9. Liu L., Wang W., Wang X., Tian C., Meng Y.H., Chang Q. Reimplantation versus remodeling: a meta-analysis // J. Card. Surg. 2011. Vol. 26 (1). P. 82–7. DOI: 10.1111/j.1540-8191.2010.01171.x.
  10. Hopkins A.R. Aortic valve leaflet sparing and salvage surgery: evolution of techniques for aortic root reconstruction // Eur. J. Cardiothorac. Surg. 2003. Vol. 24 (6). P. 886–897.
  11. Lansac E., Lim H.S., Shomura Y., Lim K.H., Rice N.T., Goetz W., Acar C., Duran C.M. A four-dimensional study of the aortic root dynamics // Eur. J. Cardiothorac. Surg. 2002. Vol. 22 (4). P. 497–503.
  12. Taylor W.J., Thrower W.B., Black H., Harken E.D. The surgical correction of aortic insufficiency by circumclusion // J. Thoracic. Surg. 1958. Vol. 35 (2). P. 192–205.
  13. Continoa М., Manginia А., Lemmaa M.G., Romagnonia C., Zerbic P., Gelpia G and Antona C. A geometric approach to aortic root surgical anatomy // Eur. J. Cardiothorac. Surg. 2016. Vol. 49 (1). P. 93–100. DOI: 10.1093/ejcts/ezv059.
  14. Harken D. The surgical treatment of acquired valvular disease // Circulation. 1958. Vol. 18 (1). P. 1–6.
  15. Starzl T.C., Cruzat E.P., Walker F.B., Lewis J.F. A technique for bicuspidization of the aortic valve // J. Thorac. Cardiovasc. Surg. 1959. Vol. 38. P. 262–70.
  16. Kunzelman K.S., Grande K.J., David T.E., Cochran R.P., Verrier E.D. Aortic root and valve relationships. Impact on surgical repair // J. Thorac. Cardiovasc. Surg. 1994. Vol. 107 (1). P. 162–70.
  17. David T.E. Aortic valve sparing operations // Ann. Thorac. Surg. 2002. Vol. 73 (4). P. 1029–1030. DOI: 10.1016/S0003-4975(02)03487-2.
  18. Boodhwani M., El Khoury G., Kerchove L. Graft sizing for aortic valve sparing surgery // Ann. Cardiothorac. Surg. 2013. Vol. 2 (1). P. 140–143.
  19. Kallenbach K., Karck M., Haverich A. Valve-sparing aortic root replacement: the inclusion (David) technique // Multimed. Man. Cardiothorac. Surg. 2007. Vol. 2007 (507). P. mmcts.2006.001917. DOI: 10.1510/mmcts.2006.001917.
  20. Успенский В.Е., Сухова И.В., Гордеев М.Л. Подходы к сохранению клапана аорты по методу David при аневризмах корня аорты, сочетающихся с аортальной недостаточностью // Артериальная гипертензия. Т. 15. № 2. С. 142–145.
  21. Shrestha M., Baraki H., Maeding I., Fitzner S., Sarikouch S., Khaladj N., Hagl C. Haverich A. Long-term results after aortic valve-sparing operation (David I) // Eur. J. Cardiothorac. Surg. 2012. Vol. 41 (1). P. 56–62. DOI: 10.1016/j.ejcts.2011.04.012.
  22. David T.E., Armstrong S., Manlhiot C., McCrindle B.W., Feindel C.M. Long-term results of aortic root repair using the reimplantation technique // J. Thorac. Cardiovasc. Surg. 2013. Vol. (3). 145. P. S22–S25. DOI: 10.1016/j.jtcvs.2012.11.075.
  23. David T.E., Maganti M., Armstrong S. Aortic root aneurysm: principles of repair and long-term follow-up // J. Thorac. Cardiovasc. Surg. 2010. Vol. 140 (6 Suppl.). P. S14–9; discussion S45–51. DOI: 10.1016/j.jtcvs.2010.07.041.
  24. Badiu C.C., Eichinger W., Bleiziffer S., Hermes G., Hettich I., Krane M., Bauernschmitt R., Lange R. Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation? // Eur. J. Cardiothorac. Surg. 2010. Vol. 38 (5). P. 515–22. DOI: 10.1016/j.ejcts.2010.03.005.
  25. Hanke T., Charitos E.I., Stierle U., Robinson D., Gorski A., Sievers H.H., Misfeld M. Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery // J. Thorac. Cardiovasc. Surg. 2009. Vol. 137 (2). P. 314–9. DOI: 10.1016/j.jtcvs.2008.08.006.
  26. Patel N.D., Weiss E.S., Alejo D.E., Nwakanma L.U., Williams J.A., Dietz H.C., Spevak P.J., Gott V.L., Vricella L.A., Cameron D.E. Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures // Ann. Thorac. Surg. 2008. Vol. 85 (6). P. 2003–10; discussion 2010–1. DOI: 10.1016/j.athoracsur.2008.01.032.
  27. Erasmi A.W., Sievers H.H., Bechtel J.F., Hanke T., Stierle U., Misfeld M. Remodeling or reimplantation for valve-sparing aortic root surgery? // Ann. Thorac. Surg. 2007. Vol. 83 (2). P. S752–6; discussion S785–90.
  28. Hanke T., Charitos E.I., Stierle U., Robinson D., Gorski A., Sievers H.H., Misfeld M. Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery // J. Thorac. Cardiovasc. Surg. 2009. Vol. 137 (2). P. 314–9. DOI: 10.1016/j.jtcvs.2008.08.006.
  29. Leyh R.G., Fischer S., Kallenbach K., Kofidis T., Pethig K., Harringer W., Haverich A. High failure rate after valve-sparing aortic root replacement using the “remodeling technique” in acute type A aortic dissection // Circulation. 2002. Vol. 106 (12 Suppl 1): P. I229–33.
  30. Bellhouse B.J., Bellhouse F., Abbot J.A., Talbot L. Mechanism of valvular incompetence in aortic sinus dilatation // Cardiovasc. Res. 1973. Vol. 7 (4). P. 490–494.
  31. De Paulis R., De Matteis G.M., Nardi P., Scaffa R., Colella D., Chiariello L. A new aortic Dacron conduit for surgical treatment of aortic root pathology // Ital. Heart J. 2000. Vol. 1 (7). P. 457–463.
  32. Чернявский А.М., Альсов С.А., Сирота Д.А., Хван Д.С., Ляшенко М.М. Результаты применения протеза с искусственными синусами Вальсальвы у пациентов с аневризмой восходящего отдела аорты и недостаточностью аортального клапана // Грудная и сердечно-сосудистая хирургия. № 3. С. 9–14.
  33. Чернявский А.М., Альсов С.А., Сирота Д.А., Хван Д.С. Хирургическая техника экстравальвулярного протезирования восходящего отдела аорты с использованием протеза с синусами Вальсальвы // Кардиология и сердечно-сосудистая хирургия. № 3. С. 41–43.
  34. Белов Ю.В., Чарчян Э.Р. Клапаносохраняющие операции у больных аневризмой восходящего отдела аорты с аортальной недостаточностью // Грудная и сердечно-сосудистая хирургия. № 1. С. 59–64.
  35. Чарчян Э.Р., Белов Ю.В., Степаненко А.Б., Генс А.П., Федулова С.В. Никонов Р.Ю. Клапансберегающие операции при расслоении аорты А типа с аортальной недостаточностью // Кардиология. Т. 54. № 6. С. 91–96.
  36. Барбухатти К.О., Болдырев С.Ю., Белаш С.А. Реконструкция корня аорты у больных с аневризмой и расслоением восходящей аорты и сопутствующей недостаточностью аортального клапана // Кардиология и сердечно-сосудистая хирургия. № 1. С. 52–55.
  37. Schoenhoff F.S., Langhammer B., Wustmann K., Reineke D., Kadner A., Carrel T. Decision-making in aortic root surgery in Marfan syndrome: bleeding, thromboembolism and risk of reintervention after valve-sparing or mechanical aortic root replacement // Eur. J. Cardiothorac. Surg. 2015. Vol. 48 (6). P. 931–936. DOI: 10.1093/ejcts/ezu553.
  38. Чернявский А.М., Хван Д.С., Альсов С.А., Сирота Д.А., Ляшенко М.М. Результаты реимплантации корня аорты в протез у пациентов с аневризмой восходящего отдела аорты и недостаточностью аортального клапана // Патология кровообращения и кардиохирургия. 2015. Т. 19. № 4. С. 38–47.

Similar Articles

You may also start an advanced similarity search for this article.