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

Slides:

Advertisements

Similar presentations

Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy Partial aortic root remodeling with selective replacement of the non-coronary.

Advertisements

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

Pericardial stentless bioprosthesis Preliminary results of a modified procedure for implantation Y. De Bruyne, B. El Nakadi & M. Joris Hopitaux civils.

Thirty-day Outcomes from the Multi-centre European Pivotal Trial for Transapical Transcatheter Aortic Valve Implantation with a Self-expanding Prosthesis.

(1) Arch Debranching vs. Elephant Trunk for Hybrid Repair of the Proximal Thoracic Aorta Arch Debranching versus Elephant Trunk Procedures for Hybrid Repair.

Conventional and frozen elephant trunk surgery for extensive aneurysmal disease of the thoracic aorta: a retrospective comparative study Marco Di Eusanio.

Fate of Un-replaced Sinuses of Valsalva in Bicuspid Aortic Valve Disease: Follow-up to 17 years Chan Park 1, Hector Michelena 2, Thoralf M. Sundt 1 Divisions.

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.

HTK Cardioprotection in Ross Procedure for Native/Prosthetic Valve Endocarditis Yoshiya Toyoda, Abul Kashem, Aki Shiose, Kazuhiro Hisamoto, Eros Leotta,

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.

Case #1 Bicuspid Valve Dilated Aortic Root Mod AI/Mild AS - RW

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

Lung Transplantation and Concomitant Cardiac Surgery: Is It Justified? Reshma Biniwale, M.D. Division of Cardiothoracic Surgery David Geffen School of.

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

Volodymyr V.Popov, Leonid L.Sytar, Olexandr A. Bolshak, Gennady V..Knyshov NY 2010 National Amosov Institute of Cardio-Vascular Surgery Kyiv, Ukraine WRAPPING.

Intraoperative Transesophageal Echocardiographic Predictors of Recurrent Aortic Regurgitation after Aortic Valve Repair le Polain JB, Pouleur AC, Vancraeynest.

Outcomes following simple and complex (Damus- Kaye-Stansel takedown) Ross operations in 62 consecutive pediatric patients Alejandra Bueno MD, David Zurakowski.

New York Aortic Surgery Symposium 2010 Mohamad Bashir, Aaron Ranasinghe, David Quin, Ben Holloway, Jorge Mascaro, Robert Bonser The limited potential for.

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

A 20-year Experience with Isolated Pericardiectomy An Analysis of Indications and Outcomes Gillaspie EA, Stulak JM, Daly RC, Greason KL, Joyce LD, Oh J,

1 Aortic Symposium 2010 Andrew W. ElBardissi, MD, MPH Sary F. Aranki, MD Lawrence H. Cohn, MD Stanton K. Shernan, MD Daniel J. FitzGerald, CCP, LP R. Morton.

Impact of early surgery vs conventional treatment for infective endocarditis on mortality and embolic events: data from EASE trial Prospective RCT ( );

Surgical outcome of native valve infective endocarditis in srinagarind hospital

Prosthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis George L. Zorn, III.

Valve Surgery V.Rohn. Valve Surgery History before the era of ECC 1925 – Suttar – first successful digital commisurolysis of mitral valve 1952 – Hufnagel.

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

Ventricular Septal Defect & Aortic Incompetence Seoul National University Hospital Department of Thoracic & Cardiovascular Surgery.

One-stage repair for Stanford Type B Aortic Dissection concomitant with cardiac diseases Open stented elephant trunk technique combined with cardiac operation.

Deep Hypothermic Circulatory Arrest in the Elderly: Is it Safe? Adam D. Zimmet, Irving L. Kron, Alan M. Speir, Clifford E. Fonner, and Ivan K. Crosby University.

Presenter: Shoujun Li, Kai Ma Department of Pediatric Cardiac Surgery, Fuwai hospital & National Center for Cardiovascular Disease, PUMC&CAMS, Beijing,

University of Lübeck Department of Cardiac and Thoracic Vascular Surgery Diagnostics in pre and post-op managment in AF patiens Thorsten Hanke.

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

The Reoperative Aortic Root: Degenerative Failure vs. Infectious Destruction – Outcomes of The “True Redo-Root” Reconstruction Rita K. Milewski, Arminder.

Concomitant Aortic Valve Repair in Patients Undergoing Continuous-flow Left Ventricular Assist Device Placement: A 10-year Experience and Clinical Implications.

Primary Mitral Regurgitation Degenerative Mitral Valve Disease

Patients Characteristics

Jeff Macemon MBChB, PDMSM Advanced Trainee, CTS

Concomitant valve sparing root remodeling with extra aortic ring annuloplasty and e-vita stented elephant trunk implantation Igor Rudez, Marko Kusurin,

Surgery for Ebstein’s Anomaly:

Choosing the valve type for AVR in old patients.

Open Repair of Ruptured Descending Thoracic and Thoracoabdominal Aortic Aneurysms in 100 Consecutive Cases Mario F. Gaudino, Christopher Lau, Monica Munjal,

Cardiovacular Research Technologies

Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes Munir Boodhwani, MD, MMSc, Laurent de Kerchove,

Extending the Scope of Mitral Valve Repair in Rheumatic Disease

Aortic Valve Repair: The Functional Approach to Leaflet Prolapse and Valve-Sparing Surgery Hugues Jeanmart, MD, Laurent de Kerchove, MD, David Glineur,

Basal cusp enlargement for repair of aortic valve insufficiency

A simple method for the quantification and correction of aortic cusp prolapse by means of free margin plication Munir Boodhwani, MD, MMSc, Laurent de.

Remodeling the Aortic Root and Preservation of the Native Aortic Valve

Hassane Abdallah, MD, Alaae Boutayeb, MD, Gebrine El Khoury, PhD

Expanding Indications for Valve-Sparing Aortic Root Reconstruction: Early and Midterm Results Johanna Valo, BM, Janne J. Jokinen, MD, PhD, Markku Kaarne,

Impact of Preoperative Symptoms on Postoperative Survival in Severe Aortic Stenosis: Implications for the Timing of Surgery Sophie Piérard, MD, Christophe.

Aortic Valve Insufficiency: Leaflet Reconstruction Techniques

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

The aortic valve–sparing operation

Aortic Root Aneurysms: Remodeling or Composite Replacement?

The Journal of Thoracic and Cardiovascular Surgery

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

Markus Liebrich, MD, Marcin K

Repair of ruptured sinus of valsalva aneurysm: Determinants of long-term survival Wing-Kuk Au, Shiu-Wah Chiu, Che-Keung Mok, Wai-Tsun Lee, David Cheung,

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

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

Distribution of patient baseline characteristics among included studies. Distribution of patient baseline characteristics among included studies. Each.

Principles of aortic valve repair

Risk of Valve-Related Events After Aortic Valve Repair

Assessment and repair of aortic valve cusp prolapse: Implications for valve-sparing procedures Munir Boodhwani, MD, MMSc, Laurent de Kerchove, MD, Christine.

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

Michael O. Kayatta, MD, Bradley G

Presentation transcript:

Bicuspid Aortic Valve Impacts the Incidence of Induced Leaflet Prolapse and Leaflet Repair Following Aortic Valve-Sparring Root Reconstruction for Aortic Root Aneurysm Joel Price, Laurent De Kerchove, David Glineur and Gebrine El Khoury Cliniques Universitaires Saint Luc, Brussels, Belgium

Background Reimplantation AVSRR is the gold-standard treatment for aortic root aneurysm with normal aortic leaflets Numerous techniques are described All change the native geometry of the functional aortic annulus This can potentially result in leaflet prolapse and aortic insufficiency

Purpose To define the incidence of induced aortic valve dysfunction following AVSRR for root aneurysm in the absence of AI The incidence of induced AI my be different in bicuspid vs tricuspid valves

Methods Retrospective study : 69 patients (14.3%) underwent AVSRR for aneurysm without significant AI (≤ 1+) Subgroup analysis for bicuspid vs tricuspid

End Points Incidence of aortic leaflet repair Need for reinstitution of CPB increased AI compared to preoperative Combined endpoint

VariableMean/Frequency n=69 Preoperative Characteristics Age (years)50 ± 16 Male62 (90%) LVEF (%)64 ± 7 EDD (mm)52 ± 6 Max Diameter (mm)51 ± 6 NYHA Class I55 (80%) II12 (17%) III2 (3%) Prior Cardiac Surgery8 (12%) Operative Characteristics Concomitant Procedure17 (25%) Cross Clamp Time (min)120 ± 41 CPB Time (min)133 ± 38

VariableFrequency n=69 Leaflet Reconstruction36 (52%) Second Pump Run1 (1.5%) Increased AI0 (0%) AI > 1+ at Discharge1(1.5%)

VariableBicuspid n=26 Tricuspid n=43 p - Value Preoperative Characteristics Age (years)48± 1451± Male39 (91%)23 (88%)1.0 LVEF (%)63 ± 766± 90.4 EDD (mm)52 ± 452 ± 71.0 Max Diameter (mm)50 ± 851± 50.7 NYHA Class0.3 I19 (73%)36 (84%) II7 (27%)5 (12%) III0(0%)2(5%) Prior Cardiac Surgery0 (0%)8 (19%)0.02 Operative Characteristics Concomitant Procedure2 (8%)15 (35%)0.008 Cross Clamp Time (min)105 ± ± CPB Time (min)119 ± 28142±

Combined End-Point P< %

AI at Discharge P=0.6 %

Midterm Freedom from AI

Conclusions AVSRR performed for root aneurysm without AI can induce leaflet prolapse and AI Bicuspid aortic valves are particularly susceptible to induced prolapse and concomitant leaflet repair is very frequently required Induced prolapse in tricuspid valves is uncommon Surgeons must be prepared to perform concomitant leaflet repair during AVSRR