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Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Root remodeling is one form of valve-preserving root replacement to treat patients with aortic regurgitation (AR) and root aneurysm. We have consistently used it for patients with and without connective tissue disease and different aortic valve morphologies. The objective of this retrospective study was to review 23 years of experience with root remodeling.

Methods and patients

Between 10/95 and 9/2018, 1004 of 1038 root remodeling procedures were performed in patients with tricuspid (n = 589) or bicuspid (n = 414) anatomy of the aortic valve in our institution. Aortic aneurysm was present in 932 cases, 73 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade I to grade IV (mean 2.5 ± 0.8).

Results

All patients underwent root remodeling, concomitant operations were performed in 433, and cusp repair in 883 instances. Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 89% at 15 years. It was 94% for tricuspid valves at 10 and 15 years, and 88% for bicuspid aortic valves at 10 years and 80% at 15 years (p = 0.003).

Conclusion

In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.

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References

  1. Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.

    Article  CAS  Google Scholar 

  2. Luciani GB, Casali G, Tomezzoli A, Mazzucco A. Recurrence of aortic insufficiency after aortic root remodeling with valve preservation. Ann Thorac Surg. 1999;67:1849–52.

    Article  CAS  Google Scholar 

  3. Leyh RG, Fischer S, Kallenbach K, et al. High failure rate after valve-sparing aortic root replacement using the "remodeling technique" in acute type A aortic dissection. Circulation. 2002;106:I229–33.

    PubMed  Google Scholar 

  4. Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg. 1998;115:1080–90.

    Article  CAS  Google Scholar 

  5. Erasmi AW, Sievers HH, Bechtel JF, Hanke T, Stierle U, Misfeld M. Remodeling or reimplantation for valve-sparing aortic root surgery? Ann Thorac Surg. 2007;83:S752–6.

    Article  Google Scholar 

  6. Aicher D, Langer F, Lausberg H, Bierbach B, Schäfers HJ. Aortic root remodeling: ten-year experience with 274 patients. J Thorac Cardiovasc Surg. 2007;134:909–15.

    Article  Google Scholar 

  7. Langer F, Graeter T, Nikoloudakis N, Aicher D, Wendler O, Schäfers HJ. Valve-preserving aortic replacement: does the additional repair of leaflet prolapse adversely affect the results? J Thorac Cardiovasc Surg. 2001;122:270–7.

    Article  CAS  Google Scholar 

  8. Asano M, Kunihara T, Aicher D, El Beyrouti H, Rodionycheva S, Schäfers HJ. Mid-term results after sinutubular junction remodelling with aortic cusp repair. Eur J Cardiothorac Surg. 2012;42:1010–5.

    Article  Google Scholar 

  9. Schäfers HJ, Aicher D, Langer F, Lausberg HF. Preservation of the bicuspid aortic valve. Ann Thorac Surg. 2007;83:S740–5.

    Article  Google Scholar 

  10. Langer F, Aicher D, Kissinger A, et al. Aortic valve repair using a differentiated surgical strategy. Circulation. 2004;110:II67–73.

    Article  Google Scholar 

  11. Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8.

    Article  Google Scholar 

  12. Lansac E, Di Centa I, Sleilaty G, et al. An aortic ring: from physiologic reconstruction of the root to a standardized approach for aortic valve repair. J Thorac Cardiovasc Surg. 2010;140:S28–35.

    Article  Google Scholar 

  13. Schäfers HJ, Aicher D. Root remodeling for aortic root dilatation. Ann Cardiothorac Surg. 2013;2:113–6.

    PubMed  PubMed Central  Google Scholar 

  14. Aicher D, Schneider U, Schmied W, Kunihara T, Tochii M, Schäfers HJ. Early results with annular support in reconstruction of the bicuspid aortic valve. J Thorac Cardiovasc Surg. 2013;145:S30–4.

    Article  Google Scholar 

  15. Graeter TP, Aicher D, Langer F, Wendler O, Schäfers HJ. Mid-term results of aortic valve preservation: remodelling vs. reimplantation. Thorac Cardiovasc Surg. 2002;50:21–4.

    Article  CAS  Google Scholar 

  16. Aicher D, Langer F, Kissinger A, Lausberg H, Fries R, Schäfers HJ. Valvesparing aortic root replacement in bicuspid aortic valves: a reasonable option? J Thorac Cardiovasc Surg. 2004;128:662–8.

    Article  Google Scholar 

  17. Schäfers HJ, Fries R, Langer F, Nikoloudakis N, Graeter T, Grundmann U. Valve-preserving replacement of the ascending aorta: remodeling versus reimplantation. J Thorac Cardiovasc Surg. 1998;116:990–6.

    Article  Google Scholar 

  18. Aicher D, Langer F, Adam O, Tscholl D, Lausberg H, Schäfers HJ. Cusp repair in aortic valve reconstruction: does the technique affect stability? J Thorac Cardiovasc Surg. 2007;134:1533–8.

    Article  Google Scholar 

  19. David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg. 2006;132:347–54.

    Article  Google Scholar 

  20. David TE, Armstrong S, Maganti M, Colman J, Bradley TJ. Long-term results of aortic valve-sparing operations in patients with Marfan syndrome. J Thorac Cardiovasc Surg. 2009;138:859–64.

    Article  Google Scholar 

  21. David TE, Feindel CM, David CM, Manlhiot C. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg. 2014;148:872–99.

    Article  Google Scholar 

  22. Boodhwani M, de Kerchove L, Watremez C, et al. Assessment and repair of aortic valve cusp prolapse: implications for valve-sparing procedures. J Thorac Cardiovasc Surg. 2011;141:917–25.

    Article  Google Scholar 

  23. Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.

    Article  CAS  Google Scholar 

  24. Miyahara S, Omura A, Sakamoto T, et al. Impact of postoperative cusp configuration on midterm durability after aortic root reimplantation. J Heart Valve Dis. 2013;22:509–16.

    PubMed  Google Scholar 

  25. Rankin JS, Gaca JG. Techniques of aortic valve repair. Innovations (Phila). 2011;6:348–54.

    Article  Google Scholar 

  26. Kunihara T, Arimura S, Sata F, Giebels C, Schneider U, Schäfers HJ. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg. 2018;155:885–94 e3.

    Article  Google Scholar 

  27. Kunihara T, Neumann N, Kriechbaum SD, Nomura R, Schäfers HJ. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J. 2017;81:1824–31.

    Article  Google Scholar 

  28. Marom G, Halevi R, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio. J Thorac Cardiovasc Surg. 2013;146:1227–31.

    Article  Google Scholar 

  29. Schneider U, Aicher D, Miura Y, Schäfers HJ. Suture annuloplasty in aortic valve repair. Ann Thorac Surg. 2016;101:783–5.

    Article  Google Scholar 

  30. Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033–42.

    Article  Google Scholar 

  31. De Paulis R, Scaffa R, Nardella S, et al. Use of the Valsalva graft and longterm follow-up. J Thorac Cardiovasc Surg. 2010;140:S23–7.

    Article  Google Scholar 

  32. Bethea BT, Fitton TP, Alejo DE, et al. Results of aortic valve-sparing operations: experience with remodeling and reimplantation procedures in 65 patients. Ann Thorac Surg. 2004;78:767–72.

    Article  Google Scholar 

  33. Kunihara T, Aicher D, Rodionycheva S, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.

    Article  Google Scholar 

  34. Aicher D, Kunihara T, Abou Issa O, Brittner B, Graber S, Schäfers HJ. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123:178–85.

    Article  Google Scholar 

  35. Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg. 2017;103:504–10.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany

    Shunsuke Miyahara, Irem Karliova, Christian Giebels, Ulrich Schneider, Shunsuke Matsushima & Hans-Joachim Schäfers

Authors
  1. Shunsuke Miyahara
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  2. Irem Karliova
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  3. Christian Giebels
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  4. Ulrich Schneider
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  5. Shunsuke Matsushima
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  6. Hans-Joachim Schäfers
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Corresponding author

Correspondence to Hans-Joachim Schäfers.

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This study was approved by the local ethics committee. Informed consent was waived for data analysis under anonymized form.

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The authors declare that they have no conflicts of interest.

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Miyahara, S., Karliova, I., Giebels, C. et al. Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results. Indian J Thorac Cardiovasc Surg 36 (Suppl 1), 81–87 (2020). https://doi.org/10.1007/s12055-019-00798-y

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  • DOI: https://doi.org/10.1007/s12055-019-00798-y

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