Valve-sparing Aortic Root Replacement: Operation Outcomes and Mid-term Follow-up of De Paulis Valsalva Graf_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XULi-li ,  YOUBin , GAOFeng , XUYi , LIPing , LIUShuo

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

YOUBin, Email: dr_youbin@hotmail.com

Keywords：

Valve-sparing aortic root replacement; De Paulis graft; David's procedure

DOI：

10.7507/1007-4848.20150281

Video：

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Objective To explore the effect of the reimplantation procedure with the De Paulis Valsalva graft in patients with aneurysms. Methods We retrospectively analyzed the clinical data of 38 patients underwent valve-sparing aortic root replacement using De Paulis graft in our hospital between September 2005 and July 2013.There were 32 male and 6 female patients at age of 45.5±12.4 years. We compared the parameters of pre-operation and post-operation and followed up the patients for 5 years. Results There were 2(5.3%) deaths in hospital. The follow-up time was 2-95 months with following-up rate of 92.1%(35/38). A total of 2 patients(5.3%) had grade 3 to grade 4 aortic insufficiency. And one of these patients received aortic valve replacement after 1 year. At 5 years of following-up, one patient died of septic shock due to pacemaker infection. One patient died of kidney failure due to renal artery dissection aneurysm affected with impaired renal function and long-term hemodialysis. Conclusion The reimplantation type of valve-sparing procedure can be facilitated by the use of the De Paulis valsalva graft and can be performed with satisfactory perioperative and mid-term results.

Citation： XULi-li, YOUBin, GAOFeng, XUYi, LIPing, LIUShuo. Valve-sparing Aortic Root Replacement: Operation Outcomes and Mid-term Follow-up of De Paulis Valsalva Graf. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(12): 1128-1132. doi: 10.7507/1007-4848.20150281 Copy

1.	Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4):338-339.
2.	Hackett D,Fessatides IT, Oakley CM, et al. Ten year follow up of models 1260 and 2400 Starr-Edwards isolated aortic valve replacement. Life Support Syst, 1985, 3(Suppl 1):148-151.
3.	Yacoub M, Rasmi NR, Sundt TM, et al. Fourteen-year experience with homovital homografts for aortic valve replacement. J Thorac Cardiovasc Surg, 1995, 110(1):186-194.
4.	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, 103(4):617-622.
5.	DeNino WF, Toole JM, Rowley C, et al. Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm. J Thorac Cardiovasc Surg, 2014, 148(6):2883-2887.
6.	Coselli JS, Hughes MS, Green SY, et al. Valve-sparing aortic root replacement:early and midterm outcomes in 83 patients. Ann Thorac Surg, 2014, 97(4):1267-1274.
7.	Stephens EH, Liang DH, Kvitting JP, et al. Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2014, 147(1):169-178.
8.	Valo J, Jokinen JJ, Kaarne M, et al. Expanding indications for valve-sparing aortic root reconstruction:early and midterm results. Ann Thorac Surg, 2013, 95(2):579-585.
9.	Liebrich M, Kruszynski MK, Roser D, et al. The David procedure in different valve pathologies:a single-center experience in 236 patients. Ann Thorac Surg, 2013, 95(1):71-76.
10.	De Paulis R, De Matteis GM, Nardi P, et al. A new aortic Dacron conduit for surgical treatment of aortic root pathology. Ital Heart J, 2000, 1(7):457-463.
11.	Coselli JS, Hughes MS, Green SY, et al. Valve-sparing aortic root replacement:early and midterm outcomes in 83 patients. Ann Thorac Surg, 2014, 97(4):1267-1274.
12.	Kvitting JP, Kari FA, Fischbein MP, et al. David valve-sparing aortic root replacement:equivalent mid-term outcome for different valve types with or without connective tissue disorder. J Thorac Cardiovasc Surg, 2013, 145(1):117-127.
13.	Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2012, 41(1):56-61.
14.	Sin YK, Pillai RG. Valve-sparing aortic root replacement. J Card Surg, 2000, 15(6):424-427.
15.	Lim JY, Kim JB, Jung SH, et al. Surgical management of aortic root dilatation with advanced aortic regurgitation:Bentall operation versus valve-sparing procedure. Korean J Thorac Cardiovasc Surg, 2012, 45(3):141-147.
16.	Tsang VT, Cameron DE, Raja SG, et al. How to avoid crimping during valve sparing aortic root replacement using the Valsalva graft. Eur J Cardiothorac Surg, 2011,40(1):266-267.
17.	Leacche M, Balaguer JM, Umakanthan R, et al. Prosthetic valve sparing aortic root replacement:an improved technique. Interact Cardiovasc Thorac Surg, 2008, 7(5):919-921.
18.	De Paulis R, Scaffa R, Nardella S, et al. Use of the Valsalva graft and long-term follow-up. J Thorac Cardiovasc Surg, 2010,140(6 Suppl):S23-27; discussion S45-51.
19.	De Paulis R. Aortic root surgery:from valve sparing to ‘spare and plasty’. Eur J Cardiothorac Surg, 2010, 38(5):513-514.
20.	Patel ND, Arnaoutakis GJ, George TJ, et al. Valve-sparing aortic root replacement in Loeys-Dietz syndrome. Ann Thorac Surg, 2011, 92(2):556-561.

1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4):338-339.
2. Hackett D,Fessatides IT, Oakley CM, et al. Ten year follow up of models 1260 and 2400 Starr-Edwards isolated aortic valve replacement. Life Support Syst, 1985, 3(Suppl 1):148-151.
3. Yacoub M, Rasmi NR, Sundt TM, et al. Fourteen-year experience with homovital homografts for aortic valve replacement. J Thorac Cardiovasc Surg, 1995, 110(1):186-194.
4. 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, 103(4):617-622.
5. DeNino WF, Toole JM, Rowley C, et al. Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm. J Thorac Cardiovasc Surg, 2014, 148(6):2883-2887.
6. Coselli JS, Hughes MS, Green SY, et al. Valve-sparing aortic root replacement:early and midterm outcomes in 83 patients. Ann Thorac Surg, 2014, 97(4):1267-1274.
7. Stephens EH, Liang DH, Kvitting JP, et al. Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2014, 147(1):169-178.
8. Valo J, Jokinen JJ, Kaarne M, et al. Expanding indications for valve-sparing aortic root reconstruction:early and midterm results. Ann Thorac Surg, 2013, 95(2):579-585.
9. Liebrich M, Kruszynski MK, Roser D, et al. The David procedure in different valve pathologies:a single-center experience in 236 patients. Ann Thorac Surg, 2013, 95(1):71-76.
10. De Paulis R, De Matteis GM, Nardi P, et al. A new aortic Dacron conduit for surgical treatment of aortic root pathology. Ital Heart J, 2000, 1(7):457-463.
11. Coselli JS, Hughes MS, Green SY, et al. Valve-sparing aortic root replacement:early and midterm outcomes in 83 patients. Ann Thorac Surg, 2014, 97(4):1267-1274.
12. Kvitting JP, Kari FA, Fischbein MP, et al. David valve-sparing aortic root replacement:equivalent mid-term outcome for different valve types with or without connective tissue disorder. J Thorac Cardiovasc Surg, 2013, 145(1):117-127.
13. Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2012, 41(1):56-61.
14. Sin YK, Pillai RG. Valve-sparing aortic root replacement. J Card Surg, 2000, 15(6):424-427.
15. Lim JY, Kim JB, Jung SH, et al. Surgical management of aortic root dilatation with advanced aortic regurgitation:Bentall operation versus valve-sparing procedure. Korean J Thorac Cardiovasc Surg, 2012, 45(3):141-147.
16. Tsang VT, Cameron DE, Raja SG, et al. How to avoid crimping during valve sparing aortic root replacement using the Valsalva graft. Eur J Cardiothorac Surg, 2011,40(1):266-267.
17. Leacche M, Balaguer JM, Umakanthan R, et al. Prosthetic valve sparing aortic root replacement:an improved technique. Interact Cardiovasc Thorac Surg, 2008, 7(5):919-921.
18. De Paulis R, Scaffa R, Nardella S, et al. Use of the Valsalva graft and long-term follow-up. J Thorac Cardiovasc Surg, 2010,140(6 Suppl):S23-27; discussion S45-51.
19. De Paulis R. Aortic root surgery:from valve sparing to ‘spare and plasty’. Eur J Cardiothorac Surg, 2010, 38(5):513-514.
20. Patel ND, Arnaoutakis GJ, George TJ, et al. Valve-sparing aortic root replacement in Loeys-Dietz syndrome. Ann Thorac Surg, 2011, 92(2):556-561.

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Valve-sparing Aortic Root Replacement: Operation Outcomes and Mid-term Follow-up of De Paulis Valsalva Graf

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