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J Thorac Cardiovasc Surg 1998;115:1080-1084
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Supported in part by the British Heart Foundation. Magdi H. Yacoub is a British Heart Foundation Professor of Cardiothoracic Surgery and Emma J. Birks is a Research Fellow supported by the British Heart Foundation (Project Grant 96152).
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.
Received for publication May 5, 1997. Revisions requested Sept. 9, 1997; revisions received Dec. 1, 1997. Accepted for publication Dec. 8, 1997. Address for reprints: Sir Magdi Yacoub, FRCS, Professor of Cardiothoracic Surgery, National Heart and Lung Institute, Heart Science Centre, Harefield Hospital, Harefield, Middlesex, UB9 6JH, United Kingdom.
Abstract
Objectives: There is still no agreement about the best method of dealing with malfunction of the aortic valve caused by aneurysm or dissection of the aortic root. The experience, rationale, and development of a valve-preserving technique introduced and used since 1979 is described.
Methods: During this period 158 patients (78% of all patients undergoing resection of aneurysm of the ascending aorta) were operated on using this technique. Their ages ranged from 2 to 72 years (mean 46.6 years). Of the patients 107 were male and 51 were female. A total of 68 patients had skeletal manifestations of Marfan's syndrome. The original disease was chronic aneurysm of the ascending aorta or root in 92 (58.2%), chronic dissection in 17 (10.8%), and acute dissection in 49 (31%) patients. One hundred eleven additional procedures were performed in 84 patients. In all there were five early deaths (4.6% ± 2%) in the 109 patients with chronic aneurysm and one death in the 103 patients operated on electively (0.97% ± 0.9%). Actuarial survival for patients operated on for chronic aneurysm was 93.3%, 88.0%, 79.0%, and 57.9% at 1, 5, 10, and 15 years and 96.8%, 91.2%, 82.0%, and 60.0% for those operated on electively. Actuarial survival for patients operated on for acute dissection was 72.8%, 63.4%, and 53.3% at 1, 5, and 10 years. The probability of needing reoperation was 3.0% ± 2%, 11% ± 0.5%, and 11% ± 0.5% at 1, 5, and 10 years. There were no instances of infective endocarditis or thromboembolic complications except in two patients operated on early in the series who had cusp extension. No anticoagulants were used. Echocardiography showed reduction in left ventricular end-systolic and end-diastolic dimensions, which was maintained. At the end of follow-up trivial or no aortic regurgitation was demonstrated in 63.6%, mild to moderate in 33.3%, and severe in 3%.
Conclusions: Valve-sparing operations are possible in a large proportion of patients with aneurysms of the ascending aorta and the medium and long-term results are encouraging.
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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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R. A. Hopkins Aortic valve leaflet sparing and salvage surgery: evolution of techniques for aortic root reconstruction Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 886 - 897. [Abstract] [Full Text] [PDF]
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K. Kirali, V. Erentug, M. B Rabus, A. Izgi, N. U Bozbuga, K. Erkanli, E. Akinci, and C. Yakut Extensive Aortic Surgery in Marfan Syndrome: 16-Year Experience Asian Cardiovasc Thorac Ann, December 1, 2003; 11(4): 337 - 341. [Abstract] [Full Text] [PDF]
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R. G. Leyh, K. Kallenbach, M. Karck, C. Hagl, S. Fischer, and A. Haverich Impact of Preoperative Aortic Root Diameter on Long-Term Aortic Valve Function After Valve Sparing Aortic Root Reimplantation Circulation, September 9, 2003; 108(90101): II-285 - 290. [Abstract] [Full Text] [PDF]
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P. Masetti, V. A. Davila-Roman, and N. T. Kouchoukos Valve-sparing procedure for dilatation of the autologous pulmonary artery and ascending aorta after the Ross operation Ann. Thorac. Surg., September 1, 2003; 76(3): 915 - 916. [Abstract] [Full Text] [PDF]
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C. A. Nienaber and K. A. Eagle Aortic Dissection: New Frontiers in Diagnosis and Management: Part II: Therapeutic Management and Follow-Up Circulation, August 12, 2003; 108(6): 772 - 778. [Full Text] [PDF]
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T. Carrel, P. Berdat, M. Pavlovic, S. Sukhanov, L. Englberger, and J.-P. Pfammatter Surgery of the dilated aortic root and ascending aorta in pediatric patients: techniques and results Eur. J. Cardiothorac. Surg., August 1, 2003; 24(2): 249 - 254. [Abstract] [Full Text] [PDF]
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A. W. Erasmi, U. Stierle, J.F. M. Bechtel, C. Schmidtke, H. H. Sievers, and E. G. Kraatz Up to 7 years' experience with valve-sparing aortic root remodeling/reimplantation for acute type a dissection Ann. Thorac. Surg., July 1, 2003; 76(1): 99 - 104. [Abstract] [Full Text] [PDF]
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A. D. Milano, S. Pratali, G. Mecozzi, P. Boraschi, G. Braccini, E. Magagnini, and U. Bortolotti Fate of coronary ostial anastomoses after the modified Bentall procedure Ann. Thorac. Surg., June 1, 2003; 75(6): 1797 - 1801. [Abstract] [Full Text] [PDF]
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D. C. Miller Valve-sparing aortic root replacement in patients with the Marfan syndrome J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 773 - 778. [Full Text] [PDF]
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T. E. David Aortic Valve Repair and Aortic Valve-Sparing Operations Card. Surg. Adult, January 1, 2003; 2(2003): 811 - 824. [Full Text]
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C. A. Anderson, R. J. Rizzo, and L. H. Cohn Ascending Aortic Aneurysms Card. Surg. Adult, January 1, 2003; 2(2003): 1123 - 1148. [Full Text]
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K. Kallenbach, C. Hagl, T. Walles, R. G. Leyh, K. Pethig, A. Haverich, and W. Harringer Results of valve-sparing aortic root reconstruction in 158 consecutive patients Ann. Thorac. Surg., December 1, 2002; 74(6): 2026 - 2033. [Abstract] [Full Text] [PDF]
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H. Matsuda, H. Ichikawa, S. Iwai, and T. Takahashi Modified aortic root remodeling for annuloaortic ectasia with abnormal coronary take-off Ann. Thorac. Surg., November 1, 2002; 74(5): 1687 - 1689. [Abstract] [Full Text] [PDF]
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T. E. David, J. Ivanov, S. Armstrong, C. M. Feindel, and G. D. Webb Aortic valve-sparing operations in patients with aneurysms of the aortic root or ascending aorta Ann. Thorac. Surg., November 1, 2002; 74(5): S1758 - 1761. [Abstract] [Full Text] [PDF]
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H.-J. Schafers, D. Aicher, and F. Langer Correction of leaflet prolapse in valve-preserving aortic replacement: pushing the limits? Ann. Thorac. Surg., November 1, 2002; 74(5): S1762 - 1764. [Abstract] [Full Text] [PDF]
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K. Kallenbach, M. Karck, R. G. Leyh, C. Hagl, T. Walles, W. Harringer, and A. Haverich Valve-sparing aortic root reconstruction in patients with significant aortic insufficiency Ann. Thorac. Surg., November 1, 2002; 74(5): S1765 - 1768. [Abstract] [Full Text] [PDF]
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E. Lansac, H.S. Lim, Y. Shomura, K.H. Lim, N.T. Rice, W. Goetz, C. Acar, and C.M.G. Duran A four-dimensional study of the aortic root dynamics Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 497 - 503. [Abstract] [Full Text] [PDF]
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J. S. Ikonomidis and D. C. Miller Stentless bioprosthetic aortic valve replacement after valve-sparing aortic root replacement J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 848 - 851. [Full Text] [PDF]
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R. G. Leyh, S. Fischer, K. Kallenbach, T. Kofidis, K. Pethig, W. Harringer, and A. Haverich High Failure Rate After Valve-sparing Aortic Root Replacement Using the "Remodeling Technique" in Acute Type A Aortic Dissection Circulation, September 24, 2002; 106(12_suppl_1): I-229 - I-233. [Abstract] [Full Text] [PDF]
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T. E. David Aortic valve sparing operations Ann. Thorac. Surg., April 1, 2002; 73(4): 1029 - 1030. [Full Text] [PDF]
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K. Morishita, G. Murakami, T. Koshino, J. Fukada, Y. Fujisawa, T. Mawatari, and T. Abe Aortic root remodeling operation: how do we tailor a tube graft? Ann. Thorac. Surg., April 1, 2002; 73(4): 1117 - 1121. [Abstract] [Full Text] [PDF]
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S. Westaby, S. Saito, and T. Katsumata Acute type A dissection: conservative methods provide consistently low mortality Ann. Thorac. Surg., March 1, 2002; 73(3): 707 - 713. [Abstract] [Full Text] [PDF]
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S. Westaby, S. Saito, K. Anastasiadis, N. Moorjani, and X.Y. Jin Aortic root remodeling in atheromatous aneurysms: The role of selected sinus repair Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 459 - 464. [Abstract] [Full Text] [PDF]
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M. E. Lewis, T. J. Jones, A. M. Ranasinghe, J. R. Lewis, and R. S. Bonser Homograft aortic root with prosthetic extension as a treatment for aneurysm of the proximal aorta in elderly patients J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 573 - 575. [Full Text] [PDF]
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N. Simon-Kupilik, H. Schima, L. Huber, R. Moidl, G. Wipplinger, U. Losert, E. Wolner, and P. Simon Prosthetic replacement of the aorta is a risk factor for aortic root aneurysm development Ann. Thorac. Surg., February 1, 2002; 73(2): 455 - 459. [Abstract] [Full Text] [PDF]
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