Modified Yacoub technique with aortic annuloplasty in patients with aortic root aneurysm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Busheng , ZHAO Naishi , YANG Tianyang ,  KONG Ye

Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, P.R. China;

Corresponding author：

KONG Ye, Email: kongye2008@outlook.com

Keywords：

Aortic root aneurysm; valve-sparing aortic root replacement; modified Yacoub technique; aortic annuloplasty

DOI：

10.7507/1007-4848.201905008

Video：

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Objective To evaluate the feasibility and safety of modified Yacoub technique with aortic annuloplasty in the patients with aortic root aneurysm and dilatation of aortic annular base.Methods We performed a retrospective review of 6 patients with aortic root aneurysm undergoing modified Yacoub technique with aortic annuloplasty from November 2017 to January 2019. There were 5 males and 1 female, with a mean age of 54.1±12.3 years. The preoperative cardiac function of 3 patients was in New York Heart Association (NYHA) classⅡand the other 3 patients were in class Ⅲ. There were two patients with bicuspid aortic valve, and no Marfan syndrome. There was aortic regurgitation in the patients measured by the echocardiogram, 1 in mild aortic regurgitation, 1 in moderate aortic regurgitation, and 4 in severe aortic regurgitation. The diameter of aortic annular base was 27.8±1.9 mm, and the largest diameter of aortic root was 49.8±3.7 mm. Six patients underwent modified Yacoub technique with aortic annuloplasty, including 5 patients who underwent aortic cusp repair at the same time.Results All 6 identified patients survived. There was no severe complication (bleeding, stroke, or acute renal failure). The cardiopulmonary bypass time was 204.6±13.5 min, aortic cross-clamping time 168.0±17.1 min, mechanical ventilation time 21.3±19.5 h, ICU stay time 67.8±62.2 h. The follow-up time ranged from 4 to 18 months with an average time of 12.8±4.7 months. Patients' cardiac function improved postoperatively with four patients in NYHA classⅠand two patients with classⅡ. Two patients had no aortic valve regurgitation, four patients had mild regurgitation. Left ventricular end diastolic volume decreased significantly (118.6±20.4 mL vs. 169.1±58.4 mL, P<0.05).Conclusion The modified Yacoub technique with aortic annuloplasty is effective and safe for the patients with aortic root aneurysm and dilatation of aortic annular base, and the early- and mid-term outcomes are satisfactory.

Citation： ZHANG Busheng, ZHAO Naishi, YANG Tianyang, KONG Ye. Modified Yacoub technique with aortic annuloplasty in patients with aortic root aneurysm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(3): 332-335. doi: 10.7507/1007-4848.201905008 Copy

1.	Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2.	Arabkhani B, Mookhoek A, Di Centa I, et al. Reported outcome after valve-sparing aortic root replacement for aortic root aneurysm: a systematic review and meta-analysis. Ann Thorac Surg, 2015, 100(3): 1126-1131.
3.	Schäfers HJ, Raddatz A, Schmied W, et al. Reexamining remodeling. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S30-S36.
4.	Oechtering TH, Sieren MM, Hunold P, et al. Time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI) reveals altered blood flow patterns in the ascending aorta of patients with valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2019, doi: 10.1016/j.jtcvs.2019.02.127. [Epub ahead of print].
5.	Gaudino M, Piatti F, Lau C, et al. Aortic flow after valve sparing root replacement with or without neosinuses reconstruction. J Thorac Cardiovasc Surg, 2019, 157(2): 455-465.
6.	Lansac E, Di Centa I, Vojacek J, et al. Valve sparing root replacement: the remodeling technique with external ring annuloplasty. Ann Cardiothorac Surg, 2013, 2(1): 117-123.
7.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
8.	Lansac E, Di Centa I, Raoux F, et al. A lesional classification to standardize surgical management of aortic insufficiency towards valve repair. Eur J Cardiothorac Surg, 2008, 33(5): 872-878.
9.	Zhu D, Zhao Q. Dynamic normal aortic root diameters: implications for aortic root reconstruction. Ann Thorac Surg, 2011, 91(2): 485-489.
10.	Schneider U, Aicher D, Miura Y, et al. Suture annuloplasty in aortic valve repair. Ann Thorac Surg, 2016, 101(2): 783-785.
11.	Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042.
12.	Mazzitelli D, Fischlein T, Rankin JS, et al. Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg, 2016, 49(3): 987-993.
13.	Schäfers HJ, Schmied W, Marom G, et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg, 2013, 146(2): 269-274.
14.	Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg, 2006, 132(2): 436-438.

1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2. Arabkhani B, Mookhoek A, Di Centa I, et al. Reported outcome after valve-sparing aortic root replacement for aortic root aneurysm: a systematic review and meta-analysis. Ann Thorac Surg, 2015, 100(3): 1126-1131.
3. Schäfers HJ, Raddatz A, Schmied W, et al. Reexamining remodeling. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S30-S36.
4. Oechtering TH, Sieren MM, Hunold P, et al. Time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI) reveals altered blood flow patterns in the ascending aorta of patients with valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2019, doi: 10.1016/j.jtcvs.2019.02.127. [Epub ahead of print].
5. Gaudino M, Piatti F, Lau C, et al. Aortic flow after valve sparing root replacement with or without neosinuses reconstruction. J Thorac Cardiovasc Surg, 2019, 157(2): 455-465.
6. Lansac E, Di Centa I, Vojacek J, et al. Valve sparing root replacement: the remodeling technique with external ring annuloplasty. Ann Cardiothorac Surg, 2013, 2(1): 117-123.
7. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
8. Lansac E, Di Centa I, Raoux F, et al. A lesional classification to standardize surgical management of aortic insufficiency towards valve repair. Eur J Cardiothorac Surg, 2008, 33(5): 872-878.
9. Zhu D, Zhao Q. Dynamic normal aortic root diameters: implications for aortic root reconstruction. Ann Thorac Surg, 2011, 91(2): 485-489.
10. Schneider U, Aicher D, Miura Y, et al. Suture annuloplasty in aortic valve repair. Ann Thorac Surg, 2016, 101(2): 783-785.
11. Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042.
12. Mazzitelli D, Fischlein T, Rankin JS, et al. Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg, 2016, 49(3): 987-993.
13. Schäfers HJ, Schmied W, Marom G, et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg, 2013, 146(2): 269-274.
14. Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg, 2006, 132(2): 436-438.

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