Remodeling+Ring (modified Yacoub) technique for the treatment of bicuspid aortic valve regurgitation with ascending aortic aneurysm: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LANG Qianlei ¹ , QIN Chaoyi ¹ , LI Yajiao ² , XIAO Zhenghua ¹ ,  MENG Wei ¹

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Vasculocardiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

MENG Wei, Email: 929831722@qq.com

Keywords：

Bicuspid aortic valve; ascending aortic aneurysm; aortic regurgitation; modified Yacoub; aortic valve repair

DOI：

10.7507/1007-4848.202010011

Video：

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Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.

Citation： LANG Qianlei, QIN Chaoyi, LI Yajiao, XIAO Zhenghua, MENG Wei. Remodeling+Ring (modified Yacoub) technique for the treatment of bicuspid aortic valve regurgitation with ascending aortic aneurysm: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 138-140. doi: 10.7507/1007-4848.202010011 Copy

1.	Svensson LG. Sizing for modified David's reimplantation procedure. Ann Thorac Surg, 2003, 76(5): 1751-1753.
2.	Tadros TM, Klein MD, Shapira OM. Ascending aortic dilatation associated with bicuspid aortic valve: Pathophysiology, molecular biology, and clinical implications. Circulation, 2009, 119(6): 880-890.
3.	陶凉, 主编. 实用主动脉根部重建术. 北京: 中国科学技术出版社, 2019. 5.
4.	Kayatta MO, Leshnower BG, McPherson L, et al. Valve-sparing root replacement provides excellent midterm outcomes for bicuspid valve aortopathy. Ann Thorac Surg, 2019, 107(2): 499-504.
5.	Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg, 1993, 105(3): 435-438.
6.	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): 617-621.
7.	Oechtering TH, Sieren MM, Hunold P, et al. Time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI) reveals altered blood flow patterns in the ascending aorta of patients with valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2020, 159(3): 798-810.
8.	Gaudino M, Piatti F, Lau C, et al. Aortic flow after valve sparing root replacement with or without neosinuses reconstruction. J Thorac Cardiovasc Surg, 2019, 157(2): 455-465.
9.	Lansac E, Di Centa I, Vojacek J, et al. Valve sparing root replacement: The remodeling technique with external ring annuloplasty. Ann Cardiothorac Surg, 2013, 2(1): 117-123.
10.	Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042.
11.	Youssefi P, Zacek P, Debauchez M, et al. Valve-sparing aortic root replacement using the remodeling technique with aortic annuloplasty: Tricuspid valves with repair of specific lesion sets: How I teach it. Ann Thorac Surg, 2019, 107(6): 1592-1599.
12.	Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2017, 52(4): 616-664.
13.	Lansac E, de Kerchove L. Aortic valve repair techniques: State of the art. Eur J Cardiothorac Surg, 2018, 53(6): 1101-1107.
14.	Svensson LG, Al Kindi AH, Vivacqua A, et al. Long-term durability of bicuspid aortic valve repair. Ann Thorac Surg, 2014, 97(5): 1539-1547.
15.	Arnaoutakis GJ, Sultan I, Siki M, et al. Bicuspid aortic valve repair: Systematic review on long-term outcomes. Ann Cardiothorac Surg, 2019, 8(3): 302-312.
16.	Aicher D, Fries R, Rodionycheva S, et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg, 2010, 37(1): 127-132.
17.	Bierbach BO, Aicher D, Issa OA, et al. Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg, 2010, 38(4): 400-406.
18.	Hasegawa J, Kitamura S, Kawata T, et al. Echocardiographic characteristics of the cryopreserved allograft aortic valve replacement assessed by intraoperative transoesophageal echocardiography. Cardiovasc Surg, 1996, 4(3): 293-298.
19.	Swanson M, Clark RE. Dimensions and geometric relationships of the human aortic valve as a function of pressure. Circ Res, 1974, 35(6): 871-882.
20.	Lansac E, Di Centa I, Sleilaty G, et al. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg, 2016, 50(2): 350-360.
21.	le Polain de Waroux JB, Pouleur AC, Robert A, et al. Mechanisms of recurrent aortic regurgitation after aortic valve repair: Predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging, 2009, 2(8): 931-939.
22.	张步升, 赵乃时, 杨天阳, 等. 瓣环加固改良 Yacoub 术在主动脉根部瘤患者中的应用. 中国胸心血管外科临床杂志, 2020, 27(3): 332-335.

1. Svensson LG. Sizing for modified David's reimplantation procedure. Ann Thorac Surg, 2003, 76(5): 1751-1753.
2. Tadros TM, Klein MD, Shapira OM. Ascending aortic dilatation associated with bicuspid aortic valve: Pathophysiology, molecular biology, and clinical implications. Circulation, 2009, 119(6): 880-890.
3. 陶凉, 主编. 实用主动脉根部重建术. 北京: 中国科学技术出版社, 2019. 5.
4. Kayatta MO, Leshnower BG, McPherson L, et al. Valve-sparing root replacement provides excellent midterm outcomes for bicuspid valve aortopathy. Ann Thorac Surg, 2019, 107(2): 499-504.
5. Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg, 1993, 105(3): 435-438.
6. 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): 617-621.
7. Oechtering TH, Sieren MM, Hunold P, et al. Time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI) reveals altered blood flow patterns in the ascending aorta of patients with valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2020, 159(3): 798-810.
8. Gaudino M, Piatti F, Lau C, et al. Aortic flow after valve sparing root replacement with or without neosinuses reconstruction. J Thorac Cardiovasc Surg, 2019, 157(2): 455-465.
9. Lansac E, Di Centa I, Vojacek J, et al. Valve sparing root replacement: The remodeling technique with external ring annuloplasty. Ann Cardiothorac Surg, 2013, 2(1): 117-123.
10. Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042.
11. Youssefi P, Zacek P, Debauchez M, et al. Valve-sparing aortic root replacement using the remodeling technique with aortic annuloplasty: Tricuspid valves with repair of specific lesion sets: How I teach it. Ann Thorac Surg, 2019, 107(6): 1592-1599.
12. Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2017, 52(4): 616-664.
13. Lansac E, de Kerchove L. Aortic valve repair techniques: State of the art. Eur J Cardiothorac Surg, 2018, 53(6): 1101-1107.
14. Svensson LG, Al Kindi AH, Vivacqua A, et al. Long-term durability of bicuspid aortic valve repair. Ann Thorac Surg, 2014, 97(5): 1539-1547.
15. Arnaoutakis GJ, Sultan I, Siki M, et al. Bicuspid aortic valve repair: Systematic review on long-term outcomes. Ann Cardiothorac Surg, 2019, 8(3): 302-312.
16. Aicher D, Fries R, Rodionycheva S, et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg, 2010, 37(1): 127-132.
17. Bierbach BO, Aicher D, Issa OA, et al. Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg, 2010, 38(4): 400-406.
18. Hasegawa J, Kitamura S, Kawata T, et al. Echocardiographic characteristics of the cryopreserved allograft aortic valve replacement assessed by intraoperative transoesophageal echocardiography. Cardiovasc Surg, 1996, 4(3): 293-298.
19. Swanson M, Clark RE. Dimensions and geometric relationships of the human aortic valve as a function of pressure. Circ Res, 1974, 35(6): 871-882.
20. Lansac E, Di Centa I, Sleilaty G, et al. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg, 2016, 50(2): 350-360.
21. le Polain de Waroux JB, Pouleur AC, Robert A, et al. Mechanisms of recurrent aortic regurgitation after aortic valve repair: Predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging, 2009, 2(8): 931-939.
22. 张步升, 赵乃时, 杨天阳, 等. 瓣环加固改良 Yacoub 术在主动脉根部瘤患者中的应用. 中国胸心血管外科临床杂志, 2020, 27(3): 332-335.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Remodeling+Ring (modified Yacoub) technique for the treatment of bicuspid aortic valve regurgitation with ascending aortic aneurysm: A case report

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