scholarly journals Mid-term durability of polytetrafluoroethylene patches in unicuspid aortic valve repair

2020 ◽  
Vol 31 (4) ◽  
pp. 555-558
Author(s):  
Irem Karliova ◽  
Tristan Ehrlich ◽  
Shunsuke Matsushima ◽  
Sebastian Ewen ◽  
Hans-Joachim Schäfers
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Severe Aortic Regurgitation ◽  
Aortic Replacement ◽  
Primary Indication ◽  
Ascending Aortic Replacement

Abstract OBJECTIVES Unicuspid aortic valve (UAV) morphology is a cause for aortic valve dysfunction in childhood or adolescence. Repair requires the use of patch material, and polytetrafluoroethylene (PTFE) has been proposed for this purpose because of lack of calcification. We reviewed our mid-term experience with PTFE for the repair of UAV to analyse the durability of this technique. METHODS Out of 21 patients with an UAV undergoing aortic valve repair for severe aortic regurgitation between 2014 and 2016, 11 patients (52%) were treated using PTFE patch material. Aortic regurgitation was present in all patients, the primary indication for surgery was regurgitation in 8, stenosis in 2 and aneurysm in 1. Symmetric bicuspidization of the UAV was performed in all. One patient required additional root remodelling for root dilatation, and another 3 tubular ascending aortic replacement. RESULTS No patient died in hospital or during follow-up. Seven patients (63.6%) required reoperation for progressive AR. Freedom from reoperation was 58% at 1 and 35% at 5 years postoperatively. At reoperation the PTFE patches were found dehisced from aortic wall and/or native cusp tissue. In 3 patients re-repair was performed; a stable result was achieved in 1. Two patients underwent valve replacement 3 months and 1 year postoperatively. The other 4 patients underwent valve replacement. CONCLUSIONS The repair of UAVs using PTFE patch is associated with poor durability, a more durable patch with better healing characteristics material is needed.

Ascending Aortic Replacement With Aortic Valve Reimplantation

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Wolfgang Harringer ◽  
Klaus Pethig ◽  
Christian Hagl ◽  
Gerd P. Meyer ◽  
Axel Haverich
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Additional Patient ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Ischemic Attack ◽  
Aortic Valve Reimplantation

Background —Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft in patients with aortic root aneurysms corrects annular ectasia and dilatation of the sinotubular junction. The durability of this valve repair with respect to the increased mechanical stress on valve cusps has been discussed, is quite controversial, and is yet unknown. Methods and Results —From July 1993 to November 1998, a replacement of the ascending aorta with a repair of the aortic valve was performed in 75 patients (53 men and 22 women aged 50±19 years). Twenty-one patients (28%) had Marfan syndrome, and 11 patients (15%) had an aortic dissection, type Stanford A (6 acute, 5 chronic). In 17 patients (23%), concomitant replacement of the aortic arch was necessary. Clinical and echocardiographic follow-up was performed in 6- to 12-month intervals for a cumulative study period of 137 patient-years. No operative deaths occurred. Two patients (3%) died 5 and 20 months postoperatively. One additional patient experienced a transient ischemic attack within the first postoperative week. Three patients (4%) with progressive aortic insufficiency required aortic valve replacement after 9, 11, and 14 months. All other patients had no or mild aortic insufficiency. The repairs have now remained stable for ≤65 months (mean, 22±20 months). Other valve-related complications did not occur. Conclusions —Our results demonstrate that this type of aortic valve repair achieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace aortic insufficiency at initial echocardiography seems to be essential for durability.

Intraoperative diagnosis of a quadricuspid aortic valve

2017 ◽  
Vol 26 (9) ◽  
pp. 704-706
Author(s):  
Hassan Tatari ◽  
Maziar Gholampour Dehaki ◽  
Gholamreza Omrani ◽  
Hafez Ghaheri ◽  
Alwaleed Al-Dairy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Incidental Finding ◽  
Aortic Valve Repair ◽  
Quadricuspid Aortic Valve ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Ventricular Septal Defect Closure

Quadricuspid aortic valve is a rare anomaly, and most patients require surgery for aortic regurgitation in the 5th or 6th decades of life; only a few cases of aortic valve repair in childhood have been reported. A 3-year-old boy was scheduled for ventricular septal defect closure and aortic valve repair. Quadricuspid aortic valve was an incidental finding at operation; it was repaired by joining the left anterior and right anterior cusps. At the 9-month follow-up, the patient had no more than mild aortic regurgitation. We emphasize the importance of detecting this anomaly, especially in children with aortic valve regurgitation.

Aortic valve neocuspidization (the Ozaki procedure)

2021 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Autologous Pericardium ◽  
Bicuspid Aortic Valves

Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic valvulopathies of various entities (aortic stenosis, aortic regurgitation, aortic valve endocarditis) in both tricuspid and bicuspid aortic valves. Thus, aortic valve neocuspidization with fixed autologous pericardium represents a versatile alternative to complex aortic valve repair, with better hemodynamics compared to biological aortic valve replacement and without the need for lifelong anticoagulation, which characterizes mechanical aortic valve replacement. The authors meticulously describe all the technical steps of this highly reproducible, standardized procedure.

scholarly journals Repair of Bicuspid Aortic Valve in the Presence of Endocarditis and Leaflet Perforation

2014 ◽  
Vol 41 (1) ◽  
pp. 67-69
Author(s):  
William D.T. Kent ◽  
Hadi D. Toeg ◽  
Jehangir J. Appoo
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Recurrent Infection ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Simplified Approach ◽  
Severe Aortic Regurgitation ◽  
History Of ◽  
Leaflet Coaptation

Aortic valve repair can be a good option in younger patients who have severe aortic regurgitation. A systematic, disease-directed approach can simplify repair. This case report describes how a simplified approach can be successfully applied to complex pathologic conditions of the aortic valve. A 49-year-old man with a bicuspid aortic valve and a history of endocarditis presented with severe aortic regurgitation and evidence of recurrent infection. Intraoperatively, we found congenital and degenerative aortic anatomy with endocarditis and perforation. We performed aortic valve repair to enable leaflet coaptation and to adjust the coaptation height. After 24 months, the patient remained well, with an intact repair and trivial aortic regurgitation. We describe our systematic repair approach and rationales for targeting repairs to identified lesions. To our knowledge, this is the first description of complex aortic valve repairs in a patient who had simultaneous congenital, degenerative, and infectious conditions.

Is small cusp size a limitation for aortic valve repair?†

2019 ◽  
Vol 56 (3) ◽  
pp. 497-502 ◽  
Author(s):  
Tatsuhiko Komiya ◽  
Takeshi Shimamoto ◽  
Michihito Nonaka ◽  
Takehiko Matsuo
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Body Height ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Patient Age ◽  
Patient Âgé ◽  
Small Cusp

Abstract OBJECTIVES We sought to investigate cusp size limitations for valve repair in patients with aortic regurgitation (AR). METHODS Preoperative computed tomography was performed in 105 patients. Cusp geometric height (GH) and annulus size were measured. Mean patient age was 60.7 ± 13.7 years. Mean GH of 3 cusps was used in the analysis. Annulus cusp mismatch was graded using predicted coaptation length. Patients were categorized by mean GH into group S (GH <16 mm; n = 35) or L (GH ≥16 mm; n = 70). RESULTS Preoperative mean GH was 17.1 ± 2.3 mm. GH and body height were significantly correlated (r = 0.61). Intraoperative mean GH (18.8 ± 2.2 mm) was larger than preoperative mean GH (P < 0.0001). However, postoperative (17.1 ± 2.0 mm) and preoperative mean GH did not differ. Moderate AR was not present on predischarge echocardiography. Mild AR was observed in 51% and 17% of patients in groups S and L, respectively (P = 0.006). During follow-up, moderate or severe AR was observed in 14% and 10% of patients in groups S and L, respectively (P = 0.74). Two patients in group S required reoperation for a regurgitant valve. Twenty (83%) and 15 (21%) patients in groups S and L, respectively, had severe annulus cusp mismatch before surgery. Annulus cusp mismatch resolved in most patients in group L postoperatively, whereas more than half the patients in group S still had severe mismatch. CONCLUSIONS Small cusp size (GH <16 mm) is not necessarily a contraindication in aortic valve repair. However, most patients in this group had annulus cusp mismatch. Root replacement or secure annulus plication is mandatory to correct annulus cusp mismatch.

scholarly journals Early outcomes of aortic valve repair versus replacement for aortic regurgitation: a single-center experience

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
Mohamed A. Amr ◽  
Elsayed Fayad
Keyword(s):  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Single Center ◽  
Valve Repair ◽  
Repair Group ◽  
Rheumatic Heart

Abstract Background Aortic valve repair in rheumatic patients is not well-studied. We aimed to present our initial Egyptian experience in the aortic valve repair and compare it with the aortic valve replacement. The study included 85 patients who had an aortic valve surgery for aortic regurgitation (AR) in a single center from 2018 to 2020. We assigned the patients to either aortic valve repair (n= 39) or aortic valve replacement (n= 46). Fifty-nine patients (69.4%) had rheumatic heart disease. Study outcomes were hospital complications and the degree of aortic regurgitation after 6 months in patients who had aortic valve repair. Results Patients who had replacement were significantly older (49.6± 7.2 vs. 43.8± 8.6 years: P= 0.002) and had more advanced New York Heart Association (P<0.001) and Canadian Cardiovascular Scoring (P= 0.03) classes. Hypertension (31 (67.4%) vs. 17 (43.6%); P= 0.03) and hypercholesteremia (18 (40%) vs. 17 (18.9%); P= 0.04) were more common in the replacement group. Patients who had replacement had a significantly higher percentage of valve retraction (P<0.001). Cardiopulmonary bypass (54.5 (49.5–60) vs. 45 (41–49) min; P<0.001) and ischemic times (36.5 (31–40) vs. 30 (28–33) min; P<0.001) were longer in patients who had an aortic valve replacement. Blood transfusion (28 (60.9%) vs. 11 (282%); P= 0.003) and ICU stay (24.5 (24–48) vs 23 (20–31) h; P= 0.01) were higher in the replacement group. Hospital mortality was non-significantly different between groups. Four patients had trivial AR (10.3%), and six had mild AR (15.4%) in the repair group. There was no difference in valve pathology or outcomes in aortic valve repair patients for degenerative versus rheumatic pathologies. After a 6-month follow-up, four patients had trivial AR (10.3%), and six patients had mild AR (15.4%) in the repair group. Conclusions Aortic valve repair could be an alternative to replacement in selected patients with rheumatic heart disease. Shorter cardiopulmonary bypass and ischemic times may improve repair outcomes compared to replacement.

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