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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. Settepani, A. Eusebio, D. Ornaghi, A. Barbone, E. Citterio, E. Manasse, G. Silvaggio, and R. Gallotti Aortic root replacement with the Carboseal composite valve graft: analysis of risk factors Interactive CardioVascular and Thoracic Surgery, August 1, 2005; 4(4): 360 - 364. [Abstract] [Full Text] [PDF]
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D. Maselli, A. Montalto, G. Santise, G. Minardi, C. Manzara, and F. Musumeci A normogram to anticipate dimension of neo-sinuses of valsalva in valve-sparing aortic operations Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 831 - 835. [Abstract] [Full Text] [PDF]
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A. Mazzola, R. Gregorini, C. Villani, and R. Giancola A simple method to adapt the height of the sinotubular junction of the De Paulis Valsalva graft to the height of the patient's sinuses in David reimplantation procedure Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 925 - 926. [Abstract] [Full Text] [PDF]
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 S. Y. Kim, N. Martin, E. C. Hsia, R. E. Pyeritz, and D. A. Albert Management of Aortic Disease in Marfan Syndrome: A Decision Analysis Arch Intern Med, April 11, 2005; 165(7): 749 - 755. [Abstract] [Full Text] [PDF]
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F. Settepani, D. Ornaghi, A. Barbone, E. Citterio, A. Eusebio, E. Manasse, G. Silvaggio, and R. Gallotti Aortic valve-sparing operations in patients with aneurysms of the aortic root or ascending aorta: preliminary results Interactive CardioVascular and Thoracic Surgery, April 1, 2005; 4(2): 137 - 139. [Abstract] [Full Text] [PDF]
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D. M. Milewicz, H. C. Dietz, and D. C. Miller Treatment of Aortic Disease in Patients With Marfan Syndrome Circulation, March 22, 2005; 111(11): e150 - e157. [Full Text] [PDF]
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E. Lansac, I. Di Centa, S. Varnous, A. Rama, F. Jault, C. M.G. Duran, C. Acar, A. Pavie, and I. Gandjbakhch External Aortic Annuloplasty Ring for Valve-Sparing Procedures Ann. Thorac. Surg., January 1, 2005; 79(1): 356 - 358. [Abstract] [Full Text] [PDF]
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W. B. Hemmer, C. A. Botha, J. O. Bohm, T. Herrmann, C. Starck, and J.-G. Rein Replacement of the Aortic Valve and Ascending Aorta With an Extended Root Stentless Xenograft Ann. Thorac. Surg., December 1, 2004; 78(6): 2150 - 2152. [Abstract] [Full Text] [PDF]
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P. Demers and D. C. Miller Simple Modification of "T. David-V" Valve-Sparing Aortic Root Replacement to Create Graft Pseudosinuses Ann. Thorac. Surg., October 1, 2004; 78(4): 1479 - 1481. [Abstract] [Full Text] [PDF]
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K. J. Zehr, T. A. Orszulak, C. J. Mullany, A. Matloobi, R. C. Daly, J. A. Dearani, T. M. Sundt III, F. J. Puga, G. K. Danielson, and H. V. Schaff Surgery for Aneurysms of the Aortic Root: A 30-Year Experience Circulation, September 14, 2004; 110(11): 1364 - 1371. [Abstract] [Full Text] [PDF]
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F. Langer, D. Aicher, A. Kissinger, O. Wendler, H. Lausberg, R. Fries, and H.-J. Schafers Aortic Valve Repair Using a Differentiated Surgical Strategy Circulation, September 14, 2004; 110(11_suppl_1): II-67 - II-73. [Abstract] [Full Text] [PDF]
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K. Kallenbach, T. Oelze, R. Salcher, C. Hagl, M. Karck, R. G. Leyh, and A. Haverich Evolving Strategies for Treatment of Acute Aortic Dissection Type A Circulation, September 14, 2004; 110(11_suppl_1): II-243 - II-249. [Abstract] [Full Text] [PDF]
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B. T. Bethea, T. P. Fitton, D. E. Alejo, C. J. Barreiro, S. M. Cattaneo, H. C. Dietz, P. J. Spevak, J. A. C. Lima, V. L. Gott, and D. E. Cameron Results of aortic valve-sparing operations: Experience with remodeling and reimplantation procedures in 65 patients Ann. Thorac. Surg., September 1, 2004; 78(3): 767 - 772. [Abstract] [Full Text] [PDF]
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P. P. Urbanski Aortic valved conduit with a stented xenograft Ann. Thorac. Surg., July 1, 2004; 78(1): 385 - 385. [Full Text] [PDF]
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J.-P. E. Kvitting, T. Ebbers, L. Wigstrom, J. Engvall, C. L. Olin, and A. F. Bolger Flow patterns in the aortic root and the aorta studied with time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging: Implications for aortic valve-sparing surgery J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1602 - 1607. [Abstract] [Full Text] [PDF]
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K. Kallenbach, R.G. Leyh, R. Salcher, M. Karck, C. Hagl, and A. Haverich Acute aortic dissection versus aortic root aneurysm: comparison of indications for valve sparing aortic root reconstruction Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 663 - 670. [Abstract] [Full Text] [PDF]
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K. Furukawa, H. Ohteki, Z.-L. Cao, Y. Narita, Y. Okazaki, S. Ohtsubo, and T. Itoh Evaluation of native valve-sparing aortic root reconstruction with direct imaging-- reimplantation or remodeling? Ann. Thorac. Surg., May 1, 2004; 77(5): 1636 - 1641. [Abstract] [Full Text] [PDF]
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M. H. Yacoub and L. H. Cohn Novel Approaches to Cardiac Valve Repair: From Structure to Function: Part II Circulation, March 9, 2004; 109(9): 1064 - 1072. [Full Text] [PDF]
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K. Minakata, H. V. Schaff, K. J. Zehr, J. A. Dearani, R. C. Daly, T. A. Orszulak, F. J. Puga, and G. K. Danielson Is repair of aortic valve regurgitation a safe alternative to valve replacement? J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 645 - 653. [Abstract] [Full Text] [PDF]
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M. Karck, K. Kallenbach, C. Hagl, C. Rhein, R. Leyh, and A. Haverich Aortic root surgery in Marfan syndrome: Comparison of aortic valve-sparing reimplantation versus composite grafting J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 391 - 398. [Abstract] [Full Text] [PDF]
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