comparison between valve sparing aortic root replacement and modified bentall allan stewart, md.,...
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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 Iribarne, MD; Brendan F.
Scully; Rachel Easterwood; Craig R. Smith, MD; Division of Cardiothoracic Surgery, Columbia University Medical
Center, New York, NY
Aortic Insufficiency & Root Aneurysm
• Different treatment options exist• Bentall Procedure1
– Several modifications• Valve-sparing root replacement (VSRR)– Sir Magdi Yacoub, Tirone David
• We have performed both at our Institution since 2005
1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 23(4):338-9.
Methods
• Retrospective study• Peri-Operative and short-term data• VSRR via the re-implantation method
described by David, et al1
• 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. 1992 April; 103(4):617-21.
Valve-Sparing Root Replacement
BioRootEdwards Perimount Valve ATS 3f Valve
BioRoot
Results
Valve-Sparing Root
ReplacementBioRoot p
Number of patients 111 175 -Mean Age in years (Range) 55 63 <0.0001
Pre-Op AI 2+ 75 (67.6%) 145 (82.6%) 0.0044
Mean Cardiopulmonary Bypass Time (min)
150.845.6 153.755.5 0.6
Mean Aortic Cross-Clamp Time (min)
112.433.4 108.934.8 0.4
Post-Op AI 2+ 0% 0% -Need for Re-op for AVR 2 (1.8%) 0 (0%) -30-day Mortality 1 (0.9%) 2 (1.1%) 0.8
Pre-Treatment Decisions
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?
Yes
Yes
Yes
No
No
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
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
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