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J Thorac Cardiovasc Surg 2001;121:1220
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Valve-preserving aortic root reconstruction

Paul P. Urbanski, MD

Herz- und Gefäß-Klinik
Salzburger Leite 1
97616 Bad Neustadt, Germany

To the Editor:

We read with interest the article by Zehr and associatesGo 1 on initial clinical experience with a new graft for valve-preserving replacement of the ascending aorta. The authors state that cusp stress "will reduce long-term durability of the valve cusps." However, this hypothesis is based only on experimental work and is not backed up by clinical observations. Yacoub and colleaguesGo 2 reported that the most common cause of surgical revision after valve-preserving replacement of the ascending aorta is progressive valve regurgitation. It is uncertain whether the new Robicsek-Thubrikar grafts will protect against this. The neo-sinuses with the crimping parallel to the longitudinal axis of the aorta might well dilate even more than usual.Go 3

Furthermore, we believe that case-based, individualized reconstruction of the sinus of Valsalva with single patches is technically easier to accomplish. Sinuses 1 to 3 are resected first (it is not always necessary to resect all three). The individually tailored patches are then sewn in as neo-sinuses. Finally, after reimplantation of the coronary ostia, the new sinotubular junction is created by anastomosis of the reconstructed sinus of Valsalva with the tube graft.

12/8/113933doi:10.1067/mtc.2001.113933

References

  1. Zehr KJ, Thubrikar MJ, Gong GG, Headrick JR, Robicsek F. Clinical introduction of a novel prosthesis for valve-preserving aortic root reconstruction for annuloaortic ectasia. J Thorac Cardiovasc Surg 2000;120:692-8.[Abstract/Free Full Text]
  2. Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg 1998;115:1080-90.[Abstract/Free Full Text]
  3. Franke U, Jurmann MJ, Uthoff K, Kohler A, Jurmann B, Wahlers T, et al. In vivo morphology of woven, collagen-sealed Dacron prostheses in the thoracic aorta. Ann Thorac Surg 1997;64:1096-8.[Abstract/Free Full Text]



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This Article
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