Valve-Sparing Aortic Root Replacement: Early Experience With the De Paulis Valsalva Graft in 51 Patients

Nishant D. Patel, Jason A. Williams, Christopher J. Barreiro, Brian T. Bethea, Torin P. Fitton, Harry C Dietz, Joao Lima, Philip J Spevak, Vincent L Gott, Luca Vricella, Duke E. Cameron

Research output: Contribution to journalArticle

Abstract

Background: Valve-sparing aortic root replacement for treatment of aortic sinus disease avoids the problems of prosthetic valves, but some patients suffer late valve incompetence as a result of leaflet distortion or annular dilatation. The reimplantation technique using the De Paulis Valsalva graft might improve late results of valve-sparing aortic root replacement by maintaining annular stability and re-creating sinuses that minimize leaflet stress. Methods: Retrospective review was conducted of all patients at our institution who underwent valve-sparing aortic root replacement using the Valsalva graft. Clinical data were obtained from hospital and clinic charts and patient contacts; echocardiograms were analyzed for aortic root dimensions and valve function. Results: Between May 2002 and June 2005, 51 patients underwent valve-sparing aortic root replacement using the reimplantation technique with the Valsalva graft. Mean age was 33 ± 15 years; 22% (11 of 51) were children, and 80% (41 of 51) were male. Primary indication for surgery was root aneurysm in all patients. Preoperative mean root diameter was 5.0 ± 0.5 cm. Marfan syndrome was present in 67% (34 of 51), and 10% (5 of 51) had the newly described Loeys-Dietz syndrome. There were no operative or late deaths, and no patient required reoperation for bleeding. At mean follow-up of 1.8 years, there were no episodes of endocarditis or thromboembolism. Echocardiograms showed stability of the annulus and root dimensions on follow-up. No patient had more than 0 to 1+ aortic insufficiency or progression of aortic insufficiency. All were in New York Heart Association class I. Conclusions: Valve-sparing aortic root replacement using the Valsalva graft and reimplantation technique has excellent early results. Preservation of valve competence is encouraging, but long-term results will determine whether the anatomic design of this aortic root prosthesis is superior for preservation of valve integrity.

Original languageEnglish (US)
Pages (from-to)548-553
Number of pages6
JournalAnnals of Thoracic Surgery
Volume82
Issue number2
DOIs
StatePublished - Aug 2006

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Aortic Valve
Transplants
Replantation
Loeys-Dietz Syndrome
Sinus of Valsalva
Aortic Diseases
Marfan Syndrome
Thromboembolism
Endocarditis
Reoperation
Mental Competency
Prostheses and Implants
Aneurysm
Dilatation
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Valve-Sparing Aortic Root Replacement : Early Experience With the De Paulis Valsalva Graft in 51 Patients. / Patel, Nishant D.; Williams, Jason A.; Barreiro, Christopher J.; Bethea, Brian T.; Fitton, Torin P.; Dietz, Harry C; Lima, Joao; Spevak, Philip J; Gott, Vincent L; Vricella, Luca; Cameron, Duke E.

In: Annals of Thoracic Surgery, Vol. 82, No. 2, 08.2006, p. 548-553.

Research output: Contribution to journalArticle

Patel, Nishant D. ; Williams, Jason A. ; Barreiro, Christopher J. ; Bethea, Brian T. ; Fitton, Torin P. ; Dietz, Harry C ; Lima, Joao ; Spevak, Philip J ; Gott, Vincent L ; Vricella, Luca ; Cameron, Duke E. / Valve-Sparing Aortic Root Replacement : Early Experience With the De Paulis Valsalva Graft in 51 Patients. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 2. pp. 548-553.
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abstract = "Background: Valve-sparing aortic root replacement for treatment of aortic sinus disease avoids the problems of prosthetic valves, but some patients suffer late valve incompetence as a result of leaflet distortion or annular dilatation. The reimplantation technique using the De Paulis Valsalva graft might improve late results of valve-sparing aortic root replacement by maintaining annular stability and re-creating sinuses that minimize leaflet stress. Methods: Retrospective review was conducted of all patients at our institution who underwent valve-sparing aortic root replacement using the Valsalva graft. Clinical data were obtained from hospital and clinic charts and patient contacts; echocardiograms were analyzed for aortic root dimensions and valve function. Results: Between May 2002 and June 2005, 51 patients underwent valve-sparing aortic root replacement using the reimplantation technique with the Valsalva graft. Mean age was 33 ± 15 years; 22{\%} (11 of 51) were children, and 80{\%} (41 of 51) were male. Primary indication for surgery was root aneurysm in all patients. Preoperative mean root diameter was 5.0 ± 0.5 cm. Marfan syndrome was present in 67{\%} (34 of 51), and 10{\%} (5 of 51) had the newly described Loeys-Dietz syndrome. There were no operative or late deaths, and no patient required reoperation for bleeding. At mean follow-up of 1.8 years, there were no episodes of endocarditis or thromboembolism. Echocardiograms showed stability of the annulus and root dimensions on follow-up. No patient had more than 0 to 1+ aortic insufficiency or progression of aortic insufficiency. All were in New York Heart Association class I. Conclusions: Valve-sparing aortic root replacement using the Valsalva graft and reimplantation technique has excellent early results. Preservation of valve competence is encouraging, but long-term results will determine whether the anatomic design of this aortic root prosthesis is superior for preservation of valve integrity.",
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T2 - Early Experience With the De Paulis Valsalva Graft in 51 Patients

AU - Patel, Nishant D.

AU - Williams, Jason A.

AU - Barreiro, Christopher J.

AU - Bethea, Brian T.

AU - Fitton, Torin P.

AU - Dietz, Harry C

AU - Lima, Joao

AU - Spevak, Philip J

AU - Gott, Vincent L

AU - Vricella, Luca

AU - Cameron, Duke E.

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AB - Background: Valve-sparing aortic root replacement for treatment of aortic sinus disease avoids the problems of prosthetic valves, but some patients suffer late valve incompetence as a result of leaflet distortion or annular dilatation. The reimplantation technique using the De Paulis Valsalva graft might improve late results of valve-sparing aortic root replacement by maintaining annular stability and re-creating sinuses that minimize leaflet stress. Methods: Retrospective review was conducted of all patients at our institution who underwent valve-sparing aortic root replacement using the Valsalva graft. Clinical data were obtained from hospital and clinic charts and patient contacts; echocardiograms were analyzed for aortic root dimensions and valve function. Results: Between May 2002 and June 2005, 51 patients underwent valve-sparing aortic root replacement using the reimplantation technique with the Valsalva graft. Mean age was 33 ± 15 years; 22% (11 of 51) were children, and 80% (41 of 51) were male. Primary indication for surgery was root aneurysm in all patients. Preoperative mean root diameter was 5.0 ± 0.5 cm. Marfan syndrome was present in 67% (34 of 51), and 10% (5 of 51) had the newly described Loeys-Dietz syndrome. There were no operative or late deaths, and no patient required reoperation for bleeding. At mean follow-up of 1.8 years, there were no episodes of endocarditis or thromboembolism. Echocardiograms showed stability of the annulus and root dimensions on follow-up. No patient had more than 0 to 1+ aortic insufficiency or progression of aortic insufficiency. All were in New York Heart Association class I. Conclusions: Valve-sparing aortic root replacement using the Valsalva graft and reimplantation technique has excellent early results. Preservation of valve competence is encouraging, but long-term results will determine whether the anatomic design of this aortic root prosthesis is superior for preservation of valve integrity.

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