Results of Valve-sparing Aortic Root Replacement for Patients with Aortic Root Aneurysm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Weidan , CHANG Qian , LI Shoujun , WANG Wei.

1. Department of Cardiac Surgery， Fu Wai Hospital， Chinese Academy of Medical Sciences &;
Peking Union Medical College， Beijing 100037;;
2. Heart Center， Guangzhou Women and Children’s Medical Center， Guangzhou Medical College， Guangzhou 510070， P. R. China;

Corresponding author：

Keywords：

Aortic valve-sparing; ?Aortic root replacement; ?Aortic root aneurysm

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Objective　To assess clinical outcomes of valve-sparing aortic root replacement for patients with aortic root aneurysm.?Methods?From February 2001 to September 2010， sixty patients with aortic root aneurysm underwent valve-sparing aortic root replacement in Fu Wai Hospital. There were 44 male patients and 16 female patients with an　average age of 37.2±13.0 years （ranging from 9-64 years）. Fifteen patients had aortic dissection， 10 patients had ascending
aorta aneurysm， 25 patients had Marfan syndrome， and 2 patients had bicuspid aortic valve. Aortic root reconstruction　was performed in 53 patients and aortic valve reimplantation was performed in 7 patients. Preoperative and postoperative heart function and degree of aortic insufficiency （AI） were compared.?Results?Valve-sparing aortic root replacement was performed in all patients. There was no in-hospital death or severe postoperative complications in this group. The　median duration of mechanical ventilation was 13 hours （ranging from 2 to 1 110 hours）， while the mean intensive care unit stay was 2.7±2.5 days （ranging from 1 to 18 days） . Postoperative echocardiography showed AI degree was significantly　reduced in all the patients. Only three patients had moderate to severe AI， and all the other patients had none or trivial AI. All the patients were followed up for 2-122 （61.5±35.9） months. During follow-up， 4 patients were lost， 9 patients died， and the overall survival rate was 83.9% （47/56）. Two patients underwent aortic valve replacement in the 13 th and 14 th postoperative month respectively because of severe AI. Heart function of 47 patients was significantly improved compared with their preoperative heart function. Thirty-five patients （74.4%）were in New York Heart Association （NYHA） functional　classⅠ， and 8 patients （17.0%） were in class II. Forty patients （85.1%）were free from moderate or severe AI.?Conclusion　Valve-sparing aortic root replacement has satisfactory long-term outcomes for patients with aortic root aneurysm， and valve-related complication rate is low.

Citation： CHEN Weidan,CHANG Qian,LI Shoujun,WANG Wei.. Results of Valve-sparing Aortic Root Replacement for Patients with Aortic Root Aneurysm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 498-501. doi: Copy

1.	David T E， Feindel C M， Bos J. Repair of the aortic valve in　patients with aortic insufficiency and aortic root aneurysm. J Thorac Cardiovasc Surg， 1995， 109 （2）：345-351.
2.	Volguina I V， Miller D C， Lemaire S A， et al. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome：analysis of early outcome. J Thorac Cardiovasc Surg， 2009， 137 （3）：641-649.
3.	Wang R， Ma WG， Tian LX， et al. Valve-sparing operation for　aortic root aneurysm in patients with Marfan syndrome. Thorac　Cardiovasc Surg， 2010， 58 （2）：76-80.
4.	David TE. Surgery of the aortic valve. Curr Probl Surg， 1999， 36 （6）：426-501.
5.	Pacini D， Petridis FD， Rasovic O， et al. Aortic valve-sparing operations. Expert Rev Cardiovasc Ther， 2010， 8 （7）：933-940.
6.	De Paulis R， De Matteis G M， Nardi P， et al. Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit. Ann Thorac Surg， 2001， 72 （2）：487-494.
7.	Erasmi A， Sievers H H， Scharfschwerdt M， et al. In vitro hydrodynamics， cusp-bending deformation， and root distensibility for different types of aortic valve-sparing operations：remodeling， sinus prosthesis， and reimplantation. J Thorac Cardiovasc Surg， 2005， 130 （4）：1044-1049.
8.	de Kerchove L， Boodhwani M， Glineur D， et al. Effects of preoperative aortic insufficiency on outcome after aortic valve-sparing surgery. Circulation， 2009， 120 （11 Suppl）：S120-S126.
9.	De Paulis R， Bassano C， Bertoldo F， et al. Aortic valve-sparing　operations and aortic root replacement. J Cardiovasc Med　（Hagerstown）， 2007， 8 （2）：97-101.
10.	Fazel SS， David TE. Aortic valve-sparing operations for aortic root and ascending aortic aneurysms. Curr Opin Cardiol， 2007， 22 （6）：497-503.
11.	Birks E J， Webb C， Child A， et al. Early and long-term results of a valve-sparing operation for Marfan syndrome. Circulation， 1999， 100 （19 Suppl）：I29-I35.
12.	Kallenbach K， Baraki H， Khaladj N， et al. Aortic valve-sparing　operation in Marfan syndrome：what do we know after a decade?? Ann Thorac Surg， 2007， 83 （2）：S764-S768， S785-S790.
13.	Settepani F， Szeto W Y， Pacini D， et al. Reimplantation valve-sparing aortic root replacement in Marfan syndrome using the Valsalva conduit：an intercontinental multicenter study. Ann Thorac Surg， 2007， 83 （2）：S769-S773， S785-S790.
14.	Roberts WC. The congenitally bicuspid aortic valve. A study of 85 autopsy cases. Am J Cardiol， 1970， 26 （1）：72-83.
15.	Sareyyupoglu B， Suri R M， Schaff H V， et al. Survival and reoperation risk following bicuspid aortic valve-sparing root replacement. J Heart Valve Dis， 2009， 18 （1）：1-8.
16.	Bakhtiary F， Monsefi N， Trendafilow M， et al. Modification of the David procedure for reconstruction of incompetent bicuspid aortic valves. Ann Thorac Surg， 2009， 88 （6）：2047-2049.
17.	Badiu CC， Eichinger W， Bleiziffer S， et al. Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation?? Eur J Cardiothorac Surg， 2010， 38 （5）：515-522.
18.	Kallenbach K， Pethig K， Schwarz M， et al. Valve sparing aortic root reconstruction versus composite replacement——perioperative course and early complications. Eur J Cardiothorac Surg， 2001， 20 （1）：77-81.

1. 　David T E， Feindel C M， Bos J. Repair of the aortic valve in　patients with aortic insufficiency and aortic root aneurysm. J Thorac Cardiovasc Surg， 1995， 109 （2）：345-351.
2. 　Volguina I V， Miller D C， Lemaire S A， et al. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome：analysis of early outcome. J Thorac Cardiovasc Surg， 2009， 137 （3）：641-649.
3. 　Wang R， Ma WG， Tian LX， et al. Valve-sparing operation for　aortic root aneurysm in patients with Marfan syndrome. Thorac　Cardiovasc Surg， 2010， 58 （2）：76-80.
4. 　David TE. Surgery of the aortic valve. Curr Probl Surg， 1999， 36 （6）：426-501.
5. 　Pacini D， Petridis FD， Rasovic O， et al. Aortic valve-sparing operations. Expert Rev Cardiovasc Ther， 2010， 8 （7）：933-940.
6. 　De Paulis R， De Matteis G M， Nardi P， et al. Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit. Ann Thorac Surg， 2001， 72 （2）：487-494.
7. 　Erasmi A， Sievers H H， Scharfschwerdt M， et al. In vitro hydrodynamics， cusp-bending deformation， and root distensibility for different types of aortic valve-sparing operations：remodeling， sinus prosthesis， and reimplantation. J Thorac Cardiovasc Surg， 2005， 130 （4）：1044-1049.
8. 　de Kerchove L， Boodhwani M， Glineur D， et al. Effects of preoperative aortic insufficiency on outcome after aortic valve-sparing surgery. Circulation， 2009， 120 （11 Suppl）：S120-S126.
9. 　De Paulis R， Bassano C， Bertoldo F， et al. Aortic valve-sparing　operations and aortic root replacement. J Cardiovasc Med　（Hagerstown）， 2007， 8 （2）：97-101.
10. 　Fazel SS， David TE. Aortic valve-sparing operations for aortic root and ascending aortic aneurysms. Curr Opin Cardiol， 2007， 22 （6）：497-503.
11. 　Birks E J， Webb C， Child A， et al. Early and long-term results of a valve-sparing operation for Marfan syndrome. Circulation， 1999， 100 （19 Suppl）：I29-I35.
12. 　Kallenbach K， Baraki H， Khaladj N， et al. Aortic valve-sparing　operation in Marfan syndrome：what do we know after a decade?? Ann Thorac Surg， 2007， 83 （2）：S764-S768， S785-S790.
13. 　Settepani F， Szeto W Y， Pacini D， et al. Reimplantation valve-sparing aortic root replacement in Marfan syndrome using the Valsalva conduit：an intercontinental multicenter study. Ann Thorac Surg， 2007， 83 （2）：S769-S773， S785-S790.
14. 　Roberts WC. The congenitally bicuspid aortic valve. A study of 85 autopsy cases. Am J Cardiol， 1970， 26 （1）：72-83.
15. 　Sareyyupoglu B， Suri R M， Schaff H V， et al. Survival and reoperation risk following bicuspid aortic valve-sparing root replacement. J Heart Valve Dis， 2009， 18 （1）：1-8.
16. 　Bakhtiary F， Monsefi N， Trendafilow M， et al. Modification of the David procedure for reconstruction of incompetent bicuspid aortic valves. Ann Thorac Surg， 2009， 88 （6）：2047-2049.
17. 　Badiu CC， Eichinger W， Bleiziffer S， et al. Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation?? Eur J Cardiothorac Surg， 2010， 38 （5）：515-522.
18. 　Kallenbach K， Pethig K， Schwarz M， et al. Valve sparing aortic root reconstruction versus composite replacement——perioperative course and early complications. Eur J Cardiothorac Surg， 2001， 20 （1）：77-81.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Results of Valve-sparing Aortic Root Replacement for Patients with Aortic Root Aneurysm

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