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Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall Allan Stewart, MD., Jonathan A. Yang, MD; Mark J. Russo, MD/MPH; Alexander.

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Presentation on theme: "Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall Allan Stewart, MD., Jonathan A. Yang, MD; Mark J. Russo, MD/MPH; Alexander."— Presentation transcript:

1 Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall Allan Stewart, MD., Jonathan A. Yang, MD; Mark J. Russo, MD/MPH; Alexander Iribarne, MD; Brendan F. Scully; Rachel Easterwood; Craig R. Smith, MD; Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY

2 Aortic Insufficiency & Root Aneurysm Different treatment options exist Bentall Procedure 1 – Several modifications Valve-sparing root replacement (VSRR) – Sir Magdi Yacoub, Tirone David We have performed both at our Institution since Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 23(4):338-9.

3 Methods Retrospective study Peri-Operative and short-term data VSRR via the re-implantation method described by David, et al 1 Modified Bentall Procedures – novel composite biologic graft 1. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg April; 103(4):

4 Valve-Sparing Root Replacement

5 BioRoot Edwards Perimount Valve ATS 3f Valve

6 BioRoot

7 Results Valve-Sparing Root Replacement BioRootp Number of patients Mean Age in years (Range)5563 < Pre-Op AI 2+75 (67.6%)145 (82.6%) Mean Cardiopulmonary Bypass Time (min) Mean Aortic Cross-Clamp Time (min) Post-Op AI 2+0% - Need for Re-op for AVR2 (1.8%)0 (0%)- 30-day Mortality1 (0.9%)2 (1.1%) 0.8

8 Pre-Treatment Decisions ReplaceRepair Normal LeafletsIsolated PathologyYoung Patient Severe Annular Dilatation (>32mm) Severe Leaflet Damage

9 Can valve be Repaired? Remodeling Real-time Repair Algorithm (AI + Aneurysm) Should it be Repaired? Ignore Repair Replace BioRoot Mechanical Conduit Reimplantation Should it be Replaced? Ye s NoNo NoNo

10 When Should We Repair? Aortic Leaflet Integrity – Reliable valve-sparing results with: supple leaflets normal annular size Bicuspid and tri-leaflets have good 10-year data – High Failure Rates with: Severe AI Multi-leaflet Prolapse Multiple Fenestrations

11 When Should We Replace? Marked leaflet Asymmetry Multiple leaflet Fenestrations Broken leaflets Bicuspid Patients – Significant Thickening – Prolapse – Calcification – Multiple Fenestrations Connective Tissue Patients – Data is unclear – Be cautious in repairing attenuated & severely prolapsed valves

12 Conclusions Similar operative times Low rates of post-op AI, repeat AVR and mortality Similar short-term outcomes Reproducible and safe Need to delineate proper guidelines for indications Follow-up needed to assess long-term outcomes


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