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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

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

To the Editor:

We read with interest the article by Zehr and associates 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 colleagues 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. 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 Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul P. Urbanski Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Urbanski, P. P. Search for Related Content PubMed PubMed Citation Articles by Urbanski, P. P. Related Collections Great vessels Valve disease