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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 617-621, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TE David and CM Feindel
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.
ARTICLES
An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta
Division of Cardiovascular Surgery, University of Toronto, Ontario, Canada.
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F. Bakhtiary, N. Monsefi, M. Trendafilow, T. Wittlinger, M. Doss, and A. Moritz Modification of the David Procedure for Reconstruction of Incompetent Bicuspid Aortic Valves Ann. Thorac. Surg., December 1, 2009; 88(6): 2047 - 2049. [Abstract] [Full Text] [PDF]
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T. E. David, S. Armstrong, M. Maganti, J. Colman, and T. J. Bradley Long-term results of aortic valve-sparing operations in patients with Marfan syndrome. J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 859 - 864. [Abstract] [Full Text] [PDF]
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E. Lansac, I. Di Centa, F. Raoux, N. Bulman-Fleming, A. Ranga, A. Abed, M. Ba, A. Paolitto, D. Letourneur, and A. Meddahi-Pelle An expansible aortic ring for a physiological approach to conservative aortic valve surgery J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 718 - 724. [Abstract] [Full Text] [PDF]
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A. M. Sheikh and T. E. David Aortic Valve-Sparing Operations: Dealing With the Coronary Artery That is Too Close to the Aortic Annulus Ann. Thorac. Surg., September 1, 2009; 88(3): 1026 - 1028. [Abstract] [Full Text] [PDF]
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N. Khaladj, I. Ismail, M. Shrestha, S. Peterss, M. Pichlmaier, K. Kallenbach, A. Haverich, and C. Hagl Aortic root surgery in combination with hypothermic circulatory arrest: preserve or replace the aortic valve in the context of postoperative neurological outcome? A case match comparison Interact CardioVasc Thorac Surg, August 1, 2009; 9(2): 246 - 250. [Abstract] [Full Text] [PDF]
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 H. Izumoto, K. Kawazoe, T. Oka, K. Ishibashi, H. Yamamoto, and F. Yamamoto Leaflet Suspension and Subvalvular Annuloplasty in Aortic Valve Prolapse Asian Cardiovascular and Thoracic Annals, June 1, 2009; 17(3): 278 - 281. [Abstract] [Full Text] [PDF]
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A. C. Kollar, S. D. Lick, and V. R. Conti Valve-Sparing Aortic Root Reconstruction Using In Situ Three-Dimensional Measurements Ann. Thorac. Surg., June 1, 2009; 87(6): 1795 - 1800. [Abstract] [Full Text] [PDF]
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S. D. Barnett and N. Ad Surgery for aortic and mitral valve disease in the United States: A trend of change in surgical practice between 1998 and 2005 J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1422 - 1429. [Abstract] [Full Text] [PDF]
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D. E. Cameron, D. E. Alejo, N. D. Patel, L. U. Nwakanma, E. S. Weiss, L. A. Vricella, H. C. Dietz, P. J. Spevak, J. A. Williams, B. T. Bethea, et al. Aortic Root Replacement in 372 Marfan Patients: Evolution of Operative Repair Over 30 Years Ann. Thorac. Surg., May 1, 2009; 87(5): 1344 - 1350. [Abstract] [Full Text] [PDF]
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I. V. Volguina, D. C. Miller, S. A. LeMaire, L. C. Palmero, X. L. Wang, H. M. Connolly, T. M. Sundt III, J. E. Bavaria, H. C. Dietz, D. M. Milewicz, et al. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1124 - 1132. [Abstract] [Full Text] [PDF]
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M. Boodhwani, L. de Kerchove, and G. El Khoury Aortic root replacement using the reimplantation technique: tips and tricks Interact CardioVasc Thorac Surg, May 1, 2009; 8(5): 584 - 586. [Abstract] [Full Text] [PDF]
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L. A. Bockeria, A. I. Malashenkov, and S. V. Rychin eComment: Aortic root replacement using the reimplantation technique: tips and tricks Interact CardioVasc Thorac Surg, May 1, 2009; 8(5): 586 - 586. [Full Text] [PDF]
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I. V. Volguina, D. C. Miller, S. A. LeMaire, L. C. Palmero, X. L. Wang, H. M. Connolly, T. M. Sundt III, J. E. Bavaria, H. C. Dietz, D. M. Milewicz, et al. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: analysis of early outcome. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 641 - 649. [Abstract] [Full Text] [PDF]
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M. Shrestha, N. Khaladj, C. Hagl, and A. Haverich Valve-Sparing Aortic Root Stabilization in Acute Type a Aortic Dissection Asian Cardiovascular and Thoracic Annals, February 1, 2009; 17(1): 22 - 24. [Abstract] [Full Text] [PDF]
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M. Boodhwani, L. de Kerchove, D. Glineur, A. Poncelet, J. Rubay, P. Astarci, R. Verhelst, P. Noirhomme, and G. El Khoury Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 286 - 294. [Abstract] [Full Text] [PDF]
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T. Hanke, E. I. Charitos, U. Stierle, D. Robinson, A. Gorski, H.-H. Sievers, and M. Misfeld 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., February 1, 2009; 137(2): 314 - 319. [Abstract] [Full Text] [PDF]
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G. Ruvolo and K. Fattouch Aortic valve-sparing root replacement from inside the aorta using three Dacron skirts preserving the native Valsalva sinuses geometry and stabilizing the annulus Interact CardioVasc Thorac Surg, February 1, 2009; 8(2): 179 - 181. [Abstract] [Full Text] [PDF]
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P. P. Urbanski, X. Zhan, S. Frank, and A. Diegeler Aortic root reconstruction using new vascular graft Interact CardioVasc Thorac Surg, February 1, 2009; 8(2): 187 - 190. [Abstract] [Full Text] [PDF]
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F. Roubertie, W. B. Ali, O. Raisky, D. Tamisier, D. Sidi, and P. R. Vouhe Aortic root replacement in children: a word of caution about valve-sparing procedures Eur J Cardiothorac Surg, January 1, 2009; 35(1): 136 - 140. [Abstract] [Full Text] [PDF]
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 M. Boodhwani, L. de Kerchove, D. Glineur, P. Noirhomme, and G. El Khoury Repair of aortic valve cusp prolapse MMCTS, January 1, 2009; 2009(0702): mmcts.2008.003806 - mmcts.2008.003806. [Abstract] [Full Text] [PDF]
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