TY - JOUR
T1 - Results of aortic valve-sparing operations
T2 - Experience with remodeling and reimplantation procedures in 65 patients
AU - Bethea, Brian T.
AU - Fitton, Torin P.
AU - Alejo, Diane E.
AU - Barreiro, Christopher J.
AU - Cattaneo, Stephen M.
AU - Dietz, Harry C.
AU - Spevak, Philip J.
AU - Lima, Joao A.C.
AU - Gott, Vincent L.
AU - Cameron, Duke E.
N1 - Funding Information:
This study was supported in part by the Dana and Albert “Cubby” Broccoli Center for Aortic Diseases at the Johns Hopkins Medical Institutions, by the Mildred and Carmont Blitz Cardiac Research Fund, National Institutes of Health grant RO1-AR41135, The Howard Hughes Medical Institute, and the Smilow Family Foundation. Doctors Brian Bethea and Christopher Barrerio are Hugh R. Sharp Jr Research Fellows, and Drs Torin Fitton and Stephen Cattaneo are Irene Piccinini Investigators. The authors wish to thank Drs Mark Redmond, Peter Greene, and John Laschinger for allowing them to include their patients in this report. They also wish to thank Eileen Wright and Barbara Dobbs for their assistance in preparing their manuscript.
PY - 2004/9
Y1 - 2004/9
N2 - Background Valve-sparing operations for aortic root aneurysms are increasing in frequency, but techniques and results are still in evolution. We reviewed our experience with 65 patients (adults and children) who had this operation at our institution to determine early and late outcomes. Methods A retrospective clinical review was undertaken using hospital records, clinical and echocardiographic, computed tomography, magnetic resonance imaging data, and telephone interviews with patients and their physicians. Results Between July 1994 and December 2002, 65 patients (46 adults and 19 children) underwent a valve-sparing operation for aortic root aneurysm. Forty-four of the patients had the Marfan syndrome; the remaining 21 had either a nonspecific connective tissue disorder (14 patients) or a miscellaneous disease process such as Ehlers-Danlos syndrome (7 patients). Fifty-eight (89%) had a David II (remodeling) procedure and 7 had a David I (reimplantation) procedure. The DePaulis "Valsalva graft" was used in six of the David I patients. There were no operative or hospital deaths; only one late death occurred in an adult due to salmonella meningitis. Overall, survival was 100% at one year and 98% at 3 and 5 years. Ten patients (7 adults and 3 children) developed significant late aortic insufficiency (AI). Nine of these patients had a David II procedure and in 8 of these cases, AI was secondary to significant late annular dilatation. One of the 10 patients developed late AI 8.2 years after a David I procedure; his AI was secondary to aortic leaflet extension and prolapse. Six of the 10 patients who developed significant late AI required aortic valve replacement (4 adults and 2 children). Freedom from late aortic valve replacement (AVR) in this series of 65 patients was 91% at 3 and 84% at 5 years. At the close of this study, 58 patients were New York Heart Association (NYHA) class I and 6 were NYHA class II; no patients were class III or IV. There were no episodes of endocarditis or clinically significant thromboembolism. Conclusions Valve-sparing operations provide satisfactory results for many patients with an aortic root aneurysm, but the David II remodeling procedure has a greater risk of late annular dilatation and AI. The David I reimplantation procedure utilizing the DePaulis Valsalva graft may obviate this problem.
AB - Background Valve-sparing operations for aortic root aneurysms are increasing in frequency, but techniques and results are still in evolution. We reviewed our experience with 65 patients (adults and children) who had this operation at our institution to determine early and late outcomes. Methods A retrospective clinical review was undertaken using hospital records, clinical and echocardiographic, computed tomography, magnetic resonance imaging data, and telephone interviews with patients and their physicians. Results Between July 1994 and December 2002, 65 patients (46 adults and 19 children) underwent a valve-sparing operation for aortic root aneurysm. Forty-four of the patients had the Marfan syndrome; the remaining 21 had either a nonspecific connective tissue disorder (14 patients) or a miscellaneous disease process such as Ehlers-Danlos syndrome (7 patients). Fifty-eight (89%) had a David II (remodeling) procedure and 7 had a David I (reimplantation) procedure. The DePaulis "Valsalva graft" was used in six of the David I patients. There were no operative or hospital deaths; only one late death occurred in an adult due to salmonella meningitis. Overall, survival was 100% at one year and 98% at 3 and 5 years. Ten patients (7 adults and 3 children) developed significant late aortic insufficiency (AI). Nine of these patients had a David II procedure and in 8 of these cases, AI was secondary to significant late annular dilatation. One of the 10 patients developed late AI 8.2 years after a David I procedure; his AI was secondary to aortic leaflet extension and prolapse. Six of the 10 patients who developed significant late AI required aortic valve replacement (4 adults and 2 children). Freedom from late aortic valve replacement (AVR) in this series of 65 patients was 91% at 3 and 84% at 5 years. At the close of this study, 58 patients were New York Heart Association (NYHA) class I and 6 were NYHA class II; no patients were class III or IV. There were no episodes of endocarditis or clinically significant thromboembolism. Conclusions Valve-sparing operations provide satisfactory results for many patients with an aortic root aneurysm, but the David II remodeling procedure has a greater risk of late annular dilatation and AI. The David I reimplantation procedure utilizing the DePaulis Valsalva graft may obviate this problem.
KW - 35
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U2 - 10.1016/j.athoracsur.2004.03.040
DO - 10.1016/j.athoracsur.2004.03.040
M3 - Article
C2 - 15336989
AN - SCOPUS:4444241250
SN - 0003-4975
VL - 78
SP - 767
EP - 772
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -