Midterm outcomes of valve-sparing aortic root replacement in patients with aortic root aneurysm and moderate to severe aortic regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Busheng ¹ , FANG Liang ¹ , DAI Huangdong ¹ , XIE Xiaoyi ² , LI Wei ¹ ,  KONG Ye ¹

1. Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China;
2. Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China;

Corresponding author：

KONG Ye, Email: kongye2008@outlook.com

Keywords：

Aortic root aneurysm; aortic regurgitation; valve-sparing aortic root replacement; aortic root reconstruction; aortic cusp repair

DOI：

10.7507/1007-4848.202106010

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Objective To evaluate the midterm effect of valve-sparing aortic root replacement (VSRR) on aortic root aneurysm and moderate to severe aortic regurgitation (AR). Methods The clinical data of patients with aortic root aneurysm and moderate to severe AR undergoing VSRR and surviving from the operation from October 2013 to May 2020 were retrospectively analyzed. There were 31 males and 9 females, with an average age of 47.1±13.4 years. There were 30 patients with true aneurysm of aortic root and 10 patients with dissecting aneurysm of aortic root. There were 3 patients with bicuspid aortic valve, and 12 patients with Marfan syndrome. The AR measured by the echocardiogram was moderate in 18 patients and severe in 22 patients. The average diameter of aortic annulus was 27.0±3.9 mm, and the mean largest diameter of aortic sinus was 52.3±6.1 mm. Results A total of 32 patients underwent David technique and 8 patients underwent Yacoub technique, and 10 patients underwent aortic cusp repair simultaneously. All 40 patients completed the follow-up, and the follow-up period was 12-86 (45.7±18.9) months. During the period, 1 patient died of heart failure, 2 had reoperation due to new-onset Stanford B aortic dissection, and no patients had reoperation related to aortic valve. The postoperative New York Heart Association cardiac function classification (1.6±0.5 vs. 2.8±0.8), left ventricular end-diastolic dimension (52.2±7.8 mm vs. 61.4±10.6 mm) and left ventricular end-diastolic volume (136.0±58.8 mL vs. 193.3±83.9 mL) of the patients were significantly improved compared with preoperative ones (P<0.05). By echocardiography, 19 patients had no AR, 18 patients had mild AR, 3 patients had mild-moderate AR, and no patients had moderate or higher AR. Conclusion In patients with aortic root aneurysm and moderate to severe AR, VSRR technique avoids prosthetic valves and anticoagulation-related complications, has lower rate of AR recurrence and reoperation, and improves the quality of life in the midterm period.

Citation： ZHANG Busheng, FANG Liang, DAI Huangdong, XIE Xiaoyi, LI Wei, KONG Ye. Midterm outcomes of valve-sparing aortic root replacement in patients with aortic root aneurysm and moderate to severe aortic regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(8): 1014-1019. doi: 10.7507/1007-4848.202106010 Copy

1.	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.
2.	Lenoir M, Maesen B, Stevens LM, et al. Reimplantation versus remodelling with ring annuloplasty: Comparison of mid-term outcomes after valve-sparing aortic root replacement. Eur J Cardiothorac Surg, 2018, 54(1): 48-54.
3.	Keeling WB, Leshnower BG, Binongo J, et al. Severity of preoperative aortic regurgitation does not impact valve durability of aortic valve repair following the David V valve sparing aortic root replacement. Ann Thorac Surg, 2017, 103(3): 756-763.
4.	Miller DC. Rationale and results of the Stanford modification of the David V reimplantation technique for valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2015, 149(1): 112-114.
5.	Maselli D, Weltert L, Scaffa R, et al. How to achieve an aortic root remodelling by performing an aortic root reimplantation. Eur J Cardiothorac Surg, 2012, 42(5): e136-e137.
6.	张步升, 赵乃时, 杨天阳, 等. 瓣环加固改良Yacoub术在主动脉根部瘤患者中的应用. 中国胸心血管外科临床杂志, 2020, 27(3): 332-335.
7.	Gocoł R, Malinowski M, Bis J, et al. Aneurysm of the aortic root and valve-sparing aortic root replacement: Long-term outcomes from a single Polish center. Kardiol Pol, 2020, 78(12): 1235-1242.
8.	Svensson LG. Root Reimplantation with leaflet repair. Semin Thorac Cardiovasc Surg, 2019, 31(2): 153-154.
9.	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.
10.	De Paulis R, Chirichilli I, Scaffa R, et al. Long-term results of the valve reimplantation technique using a graft with sinuses. J Thorac Cardiovasc Surg, 2016, 151(1): 112-119.
11.	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.
12.	Youssefi P, El-Hamamsy I, Lansac E. Rationale for aortic annuloplasty to standardise aortic valve repair. Ann Cardiothorac Surg, 2019, 8(3): 322-330.
13.	David TE. Aortic root aneurysms: Remodeling or composite replacement? Ann Thorac Surg, 1997, 64(5): 1564-1568.
14.	Svensson LG. Sizing for modified David's reimplantation procedure. Ann Thorac Surg, 2003, 76(5): 1751-1753.
15.	de Kerchove L, Mosala Nezhad Z, Boodhwani M, et al. How to perform valve sparing reimplantation in a tricuspid aortic valve. Ann Cardiothorac Surg, 2013, 2(1): 105-112.
16.	Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg, 2000, 119(5): 975-982.
17.	Mastrobuoni S, de Kerchove L, Navarra E, et al. Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation. J Thorac Cardiovasc Surg, 2019, 158(1): 14-23.
18.	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.
19.	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.
20.	Lavon K, Halevi R, Marom G, et al. Fluid-structure interaction models of bicuspid aortic valves: The effects of nonfused cusp angles. J Biomech Eng, 2018, 140(3).
21.	Liebrich M, Charitos E, Stadler C, et al. Additional cusp reconstruction does not compromise valve durability and mid-term survival after the David procedure: Results from 449 patients. Eur J Cardiothorac Surg, 2020, 58(5): 1072-1079.

1. 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.
2. Lenoir M, Maesen B, Stevens LM, et al. Reimplantation versus remodelling with ring annuloplasty: Comparison of mid-term outcomes after valve-sparing aortic root replacement. Eur J Cardiothorac Surg, 2018, 54(1): 48-54.
3. Keeling WB, Leshnower BG, Binongo J, et al. Severity of preoperative aortic regurgitation does not impact valve durability of aortic valve repair following the David V valve sparing aortic root replacement. Ann Thorac Surg, 2017, 103(3): 756-763.
4. Miller DC. Rationale and results of the Stanford modification of the David V reimplantation technique for valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2015, 149(1): 112-114.
5. Maselli D, Weltert L, Scaffa R, et al. How to achieve an aortic root remodelling by performing an aortic root reimplantation. Eur J Cardiothorac Surg, 2012, 42(5): e136-e137.
6. 张步升, 赵乃时, 杨天阳, 等. 瓣环加固改良Yacoub术在主动脉根部瘤患者中的应用. 中国胸心血管外科临床杂志, 2020, 27(3): 332-335.
7. Gocoł R, Malinowski M, Bis J, et al. Aneurysm of the aortic root and valve-sparing aortic root replacement: Long-term outcomes from a single Polish center. Kardiol Pol, 2020, 78(12): 1235-1242.
8. Svensson LG. Root Reimplantation with leaflet repair. Semin Thorac Cardiovasc Surg, 2019, 31(2): 153-154.
9. 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.
10. De Paulis R, Chirichilli I, Scaffa R, et al. Long-term results of the valve reimplantation technique using a graft with sinuses. J Thorac Cardiovasc Surg, 2016, 151(1): 112-119.
11. 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.
12. Youssefi P, El-Hamamsy I, Lansac E. Rationale for aortic annuloplasty to standardise aortic valve repair. Ann Cardiothorac Surg, 2019, 8(3): 322-330.
13. David TE. Aortic root aneurysms: Remodeling or composite replacement? Ann Thorac Surg, 1997, 64(5): 1564-1568.
14. Svensson LG. Sizing for modified David's reimplantation procedure. Ann Thorac Surg, 2003, 76(5): 1751-1753.
15. de Kerchove L, Mosala Nezhad Z, Boodhwani M, et al. How to perform valve sparing reimplantation in a tricuspid aortic valve. Ann Cardiothorac Surg, 2013, 2(1): 105-112.
16. Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg, 2000, 119(5): 975-982.
17. Mastrobuoni S, de Kerchove L, Navarra E, et al. Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation. J Thorac Cardiovasc Surg, 2019, 158(1): 14-23.
18. 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.
19. 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.
20. Lavon K, Halevi R, Marom G, et al. Fluid-structure interaction models of bicuspid aortic valves: The effects of nonfused cusp angles. J Biomech Eng, 2018, 140(3).
21. Liebrich M, Charitos E, Stadler C, et al. Additional cusp reconstruction does not compromise valve durability and mid-term survival after the David procedure: Results from 449 patients. Eur J Cardiothorac Surg, 2020, 58(5): 1072-1079.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Midterm outcomes of valve-sparing aortic root replacement in patients with aortic root aneurysm and moderate to severe aortic regurgitation

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