TrueRaphe’d Bicuspid aortic valve (BAV) repair with valve-sparing root replacement (VSRR): the state-of-the-art? Thomas G. Gleason, M.D., Forozan Navid,

Slides:

Advertisements

Similar presentations

Allan Stewart, MD. , Jonathan A. Yang, MD; Mark J

Advertisements

AVR: Choice of Prosthesis Tirone E. David University of Toronto.

Antegrade Stent Grafting of Descending Thoracic Aorta During Acute Debakey I Dissection: Early and Midterm Outcomes Prashanth Vallabhajosyula MD, Joseph.

Aortic Root Conservative Repair in Acute Type A Aortic Dissection Involving Aortic Root: Fate of Aortic Root & Aortic Valve Function Joon Bum Kim, Su Kyung.

Bicuspid Aortic Valve Impacts the Incidence of Induced Leaflet Prolapse and Leaflet Repair Following Aortic Valve-Sparring Root Reconstruction for Aortic.

Aortic Valve Repair. Aortic Root Annulus Cusp Sinus ST junction Sub Commissure Triangle.

Long-Term Outcomes and Modes of Failure of the Ross Operation in Patients with Aortic Insufficiency Joel Price MD, MPH, Laurent De Kerchove MD, David Glineur.

Khalil Fattouch, Roberta Sampognaro, Giuseppe Speziale, Marco Caruso, Pietro Dioguardi, Salvatore Novo, Giovanni Ruvolo. Disclosures: None Disclosures:

Nimesh D. Desai MD PHD, Alberto Pochettino MD, Wilson Szeto MD, William Moser RN, Kanika Gupta BA, Patrick Moeller BA, Joseph E. Bavaria MD Hospital of.

Long terms results after bicuspid aortic valve repair according to functional classification of aortic insufficiency Khalil Fattouch, Giacomo Murana, Sebastiano.

How I Would Like By Bicuspid Valve and Aneurysms Treated Thoralf M. Sundt,MD AATS Skills April 25,2015.

Long Term Outcomes of Aortic Root Operations for Marfan Syndrome: A Comparison of Bentall versus Aortic Valve-Sparing Procedures Joel Price, MD, J. Trent.

Nimesh Desai MD, Fenton McCarthy, Wilson Szeto MD, Alberto Pochettino MD, Richard Erwin, Yasmin El-Sayed, Joseph Bavaria MD Thoracic Aortic Research Program.

Central Cannulation Strategy Via Left Thoracotomy in the Treatment of Chronic or Residual Type B Dissection Extent I Thoracoabdominal + Distal Aortic Arch.

Aortic Root Dilatation S/P Ross Procedure

Long-term Survival, Valve Durability, and Reoperation for Four Aortic Root + Ascending Procedures Lars G. Svensson, Saila T. Pillai, Jeevanantham Rajeswaran,

3/98medslides.com1 Aortic Valve Homografts A Cinical Perspective Michael E. Staab, MD Rick A. Nishimura, MD Joseph A. Dearani, MD Thomas A. Orszulak, MD.

Ross Operation Seoul National University Hospital Department of Thoracic & Cardiovascular Surgery.

Date of download: 9/18/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved. Reimplantation (David-I) valve-sparing aortic root replacement-

Aortic Valve Homografts A Cinical Perspective

Bicuspid aortic valve repair by complete conversion from “raphe'd” (type 1) to “symmetric” (type 0) morphology Thomas G. Gleason, MD The Journal of.

Valve-Sparing Aortic Root Replacement

Aortic Valve Reconstruction in the Young Infants and Children

Scott Goldman, MD, Anson Cheung, MD, Joseph E. Bavaria, MD, Michael R

Segmental Approach to Repair of Regurgitant Bicuspid Aortic Valves

Modified button-Bentall operation for aortic root replacement: the miniskirt technique Guido Michielon, MD, Loris Salvador, MD, Uberto Da Col, MD, Carlo.

Aortic Valve Repair Delos M. Cosgrove, Charles D. Fraser

Aortic valve–sparing reimplantation for dilatation of the ascending aorta and aortic regurgitation late after repair of congenital heart disease Masamichi.

Aortic Valve Repair Munir Boodhwani, MD, MMSc, Gebrine El Khoury, MD

Basal cusp enlargement for repair of aortic valve insufficiency

Toward individualized management of the ascending aorta in bicuspid aortic valve surgery: The role of valve phenotype in 1362 patients Hans-Hinrich Sievers,

New graft formulation and modification of the David reimplantation technique Thomas G. Gleason, MD The Journal of Thoracic and Cardiovascular Surgery

New Technique of Aortic Root Reconstruction With Aortic Valve Annuloplasty in Ascending Aortic Aneurysm Akhtar Rama, MD, Sylvain Rubin, MD, Nicolas Bonnet,

Cardiovascular operations for Loeys-Dietz syndrome: Intermediate-term results Nishant D. Patel, MD, Todd Crawford, MD, J. Trent Magruder, MD, Diane E.

Ahmad Zeeshan, MD, Jay J. Idrees, MD, Douglas R

Measurement of Mitral Leaflet and Annular Geometry and Stress After Repair of Posterior Leaflet Prolapse: Virtual Repair Using a Patient-Specific Finite.

Long-Term Durability of Bicuspid Aortic Valve Repair

Novel Technique of Valve-Sparing Aortic Root Replacement in Two Children Younger Than 3 Years of Age James K. Kirklin, MD, Walter H. Johnson, MD, Barton.

Alessandro Della Corte, MD, PhD, Simon C. Body, MBChB, MPH, Anna M

Aortic Valve Insufficiency: Leaflet Reconstruction Techniques

Aortic replacement for bicuspid aortic valve aortopathy: When and why?

Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair

Vikas Sharma, MBBS, Rakesh M. Suri, MD, DPhil, Joseph A

Aortic Valve-Sparing Procedure With Cusp Elongation and Free Edge Reinforcement for Bicuspid Aortic Valve Francois Dagenais, MD, Richard Bauset, MD,

The aortic valve–sparing operation

Aortic Valve Repair Munir Boodhwani, MD, MMSc, Gebrine El Khoury, MD

Aortic Root Aneurysms: Remodeling or Composite Replacement?

Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function in Marfan Syndrome Patients Seyed Hossein Aalaei-Andabili, MD, Tomas Martin, MD,

Bicuspid Aortic Valve Resuspension in Acute Type A Aortic Dissection Patients Bartosz Rylski, MD, Matthias Siepe, MD, Friedhelm Beyersdorf, MD, PhD, Fabian.

Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: Comparison with the 3-cusp David procedure Joseph E. Bavaria, MD, Nimesh.

Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease Fabian A. Kari, MD, David H. Liang, MD, PhD, John-Peder.

Factors impacting long-term pulmonary autograft durability after the Ross procedure Ravil Sharifulin, MD, Alexander Bogachev-Prokophiev, MD, Sergey Zheleznev,

Root Stabilization of the Repaired Bicuspid Aortic Valve: Subcommissural Annuloplasty Versus Root Reimplantation Prashanth Vallabhajosyula, MD, MS, Caroline.

Markus Liebrich, MD, Marcin K

Ulrich Schneider, MD, Susanne K

Paul Urbanski, MD, PhD The Annals of Thoracic Surgery

Functional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring

Remodeling root repair with an external aortic ring annuloplasty

Javariah Siddiqui, MBBS, Christian P. Brizard, MD, Igor E

Root Remodeling and Aortic Valve Repair for Unicuspid Aortic Valve

To pleat or not to pleat…is that the question?

Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair Laurent de Kerchove, MD,

Analysis of valve motion after the reimplantation type of valve-sparing procedure (David I) with a new aortic root conduit Ruggero De Paulis, MD, Giovanni.

Comparing Aortic Root Replacements: Porcine Bioroots Versus Pericardial Versus Mechanical Composite Roots: Hemodynamic and Ventricular Remodeling at Greater.

A new technique for aortic valve dysfunction: reconstruction by posterior leaflet of tricuspid valve Hansong Sun, MD, Qiang Wang, MD, Shengshou Hu, MD,

Remodeling of the aortic root and reconstruction of the bicuspid aortic valve Hans-Joachim Schäfers, MD, PhD, Frank Langer, MD, Diana Aicher, MD, Thomas.

Bicuspid Aortic Insufficiency With Aortic Root Aneurysm: Root Reimplantation Versus Bentall Root Replacement Prashanth Vallabhajosyula, MD, Wilson Y.

Durability of Truncal Valve Repair

Reimplantation Valve-Sparing Aortic Root Replacement in Marfan Syndrome Using the Valsalva Conduit: An Intercontinental Multicenter Study Fabrizio Settepani,

Presentation transcript:

TrueRaphe’d Bicuspid aortic valve (BAV) repair with valve-sparing root replacement (VSRR): the state-of-the-art? Thomas G. Gleason, M.D., Forozan Navid, M.D., Wilson Szeto, M.D., Joseph E. Bavaria, M.D. University of Pittsburgh and University of Pennsylvania

True BAV with insufficiency Raphe’d BAV with stenosis Variable morphological and clinical phenotypes dictate candidacy for preservation

Valve-sparing Root Replacement: Modified Reimplantation Technique Gleason, JTCVS 2005;130:601-3.

Valve repair & reimplantation: MRA depicts neosinus creation TricuspidRepaired bicuspid (true) Repaired bicupsid (raphe)

Aortic valve repair maneuvers used Central or commissural cusp plication Central or commissural cusp plication Cusp resections (triangular) Cusp resections (triangular) Pericardial patch-leaflet replacement Pericardial patch-leaflet replacement Commissuroplasty Commissuroplasty Leading edge reinforcement/shortening Leading edge reinforcement/shortening Rudimentary commissural release Rudimentary commissural release Annuloplasty Annuloplasty

Circulation 2007;116 [suppl I]:I

Post AV repair (triangular resection, commissuroplasty), root replacement, valve reimplantation. Triangular resection Commissuroplasty

Post-repair (triangular resection)

2 VSRR techniques used U Pitt 15 cases all using modified reimplantation technique (tailored graft) (Gleason Root graft sizes mm U Pitt 15 cases all using modified reimplantation technique (tailored graft) (Gleason JTCVS 2005;130:601-3.) Root graft sizes mm Final internal annular diameter mm Final internal annular diameter mm 4 pleats used to create 2 sinuses 4 pleats used to create 2 sinuses annular sutures used for annuloplasty annular sutures used for annuloplasty Mean cusp depth 19.4 mm Mean cusp depth 19.4 mm 2-7 leaflet maneuvers/case (mean 4/case) 2-7 leaflet maneuvers/case (mean 4/case) HUP 8 cases all using commercial “Valsalva graft” (Cameron Ann Thorac Surg 2006;82: )

Demographics: 23 patients Mean age 45.5 (range 33-66) Mean age 45.5 (range 33-66) 19 male 19 male Procedures performed in all 23 patients: Procedures performed in all 23 patients: VSRR 23 VSRR 23 Complex AV repair 8 Complex AV repair 8 Annuloplasty 15 Annuloplasty 15 Hemiarch replacement 21 Hemiarch replacement 21 Cox-maze III 1 Cox-maze III 1 Max aortic orthogonal diameter 53.7 mm (range 48-65mm) Max aortic orthogonal diameter 53.7 mm (range 48-65mm) Aortic regurgitation Aortic regurgitation 0-trace: 5 pts. 0-trace: 5 pts. 1+ : 8 pts. 1+ : 8 pts. 2+ : 3 pts. 2+ : 3 pts. 3+ : 4 pts. 3+ : 4 pts. 4+ : 3 pts. 4+ : 3 pts.

Bicuspid aortic valve repair & reimplantation with VSRR 23 VSRR for BAV and TAA 23 VSRR for BAV and TAA 8 with AV repair 8 with AV repair 15 without AV repair 15 without AV repair 7 true BAV 7 true BAV 16 BAV with raphe 16 BAV with raphe Follow-up (2-68 mos, mean 34 ±4 mos) Follow-up (2-68 mos, mean 34 ±4 mos) 0% mortality 0% mortality 0% stroke 0% stroke 0% PPMs 0% PPMs 0% reoperations 0% reoperations 100% freedom from ≥ 2+ AR 100% freedom from ≥ 2+ AR 8.6% 1+ AR 8.6% 1+ AR 91% 0-trace AR 91% 0-trace AR

Assessment for aortic valve repair/VSRR A.A good repair is better than a good (bio)prosthesis i.No anticoagulation ii.Potential for longer (indefinite) durability iii.Potential for better hemodynamic profile B.Pitfalls i.Patient selection ii.Understanding the “pathodynamics” of the valve iii.Technically more difficult