Modified Yacoub technique for patients with aortic root aneurysm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Hongjia , LANG Qianlei , QIN Chaoyi , QIAN Hong , XIAO Zhenghua ,  MENG Wei

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

Corresponding author：

MENG Wei, Email: 929831722@qq.com

Keywords：

Aortic root aneurysm; valve-sparing aortic root replacement; aortic annuloplasty; modified Yacoub technique

DOI：

10.7507/1007-4848.202401055

Video：

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Objective To evaluate the feasibility and safety of Remodeling+Ring (modified Yacoub) for patients with aortic root aneurysm. Methods The clinical data of patients who underwent modified Yacoub surgery at West China Hospital of Sichuan University from July 2020 to May 2023 were retrospectively analyzed. Results Four male patients were enrolled, with an average age of 47.3±10.3 years and body surface area of 1.9±0.2 m². One patient had a complication of bicuspid aortic valve. Aortic valve regurgitation was mild in three patients and moderate in one patient. Preoperative New York Heart Association (NYHA) heart function was gradeⅠin one patient and gradeⅡin three patients, and the body surface area was 1.9±0.2 m². The maximum diameter of the aortic sinus was 59.3±8.1 mm. All four patients recovered and were discharged without a second thoracotomy. No postoperative complications such as brain injury, infection, respiratory failure or renal insufficiency occurred. During the follow-up of 17.0±13.1 months, two patients showed no regurgitation of the aortic valve, two patients exhibited mild regurgitation. Three patients had a heart function of gradeⅠ and one patient of gradeⅡ. Conclusion Modified Yacoub technique is safe and effective for patients with aortic root aneurysm.

1.	Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2.	Crawford ES, Svensson LG, Coselli JS, et al. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients. J Thorac Cardiovasc Surg, 1989, 98(5 Pt 1): 659-673, discussion 673-4.
3.	De Paulis R, Scaffa R, Maselli D, et al. Valsalva graft in the Bentall procedure: From mechanical valve to the BioValsalva, world's first biological aortic conduit. Surg Technol Int, 2008, 17: 216-221.
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): 617-621,discussion 22.
5.	Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg, 1993, 105(3): 435-438.
6.	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.
7.	Shraer N, Youssefi P, Zacek P, et al. Bicuspid valve repair outcomes are improved with reduction and stabilization of sinotubular junction and annulus with external annuloplasty. J Thorac Cardiovasc Surg, 2022. [Epub ahead of print].
8.	Schäfers HJ, Schmied W, Marom G, et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg, 2013, 146(2): 269-274.
9.	Schneider U, Feldner SK, Hofmann C, et al. Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg, 2017, 153(4): S65-S71.
10.	Salica A, Pisani G, Morbiducci U, et al. The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve. Eur J Cardiothorac Surg, 2016, 49(4): 1222-1227.
11.	Hanke T, Charitos EI, Stierle U, et al. Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery. J Thorac Cardiovasc Surg, 2009, 137(2): 314-319.
12.	Bilkhu R, Tome M, Marciniak A, et al. Does the aortic annulus dilate after aortic root remodeling? Ann Thorac Surg, 2020, 110(3): 943-947.
13.	Devine K, Augoustides JG. Aortic valve repair: The evolving frontiers of aortic annuloplasty. J Cardiothorac Vasc Anesth, 2022, 36(11): 3999-4000.
14.	Cabrol C, Cabrol A, Guiraudon G, et al. Treatment of aortic insufficiency by means of aortic annuloplasty. Arch Mal Coeur Vaiss, 1966, 59(9): 1305-1312.
15.	Taylor W J, Thrower W B, Black H, et al. The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg, 1958, 35(2): 192-205 passim.
16.	Federspiel JM, Ehrlich T, Abeln K, et al. Aortic annuloplasty: Subcommissural, intra-annular suture techniques, external and internal rings. JTCVS Tech, 2021, 7: 98-102.
17.	Mazzitelli D, Fischlein T, Rankin JS, et al. Geometric ring annuloplasty as an adjunct to aortic valve repair: Clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg, 2016, 49(3): 987-993.
18.	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.
19.	Schäfers HJ, Raddatz A, Schmied W, et al. Reexamining remodeling. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S30-S36.
20.	Seki M, Kunihara T, Takada J, et al. Comparison of hemodynamics and root configurations between remodeling and reimplantation methods for valve-sparing aortic root replacement: A pulsatile flow study. Surg Today, 2023, 53(7): 845-854.
21.	De Kerchove L, Momeni M, Aphram G, et al. Free margin length and coaptation surface area in normal tricuspid aortic valve: An anatomical study. Eur J Cardiothorac Surg, 2018, 53(5): 1040-1048.
22.	Oka T, Okita Y, Matsumori M, et al. Aortic regurgitation after valve-sparing aortic root replacement: Modes of failure. Ann Thorac Surg, 2011, 92(5): 1639-1644.
23.	Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg, 2006, 132(2): 436-438.
24.	Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.

1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2. Crawford ES, Svensson LG, Coselli JS, et al. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients. J Thorac Cardiovasc Surg, 1989, 98(5 Pt 1): 659-673, discussion 673-4.
3. De Paulis R, Scaffa R, Maselli D, et al. Valsalva graft in the Bentall procedure: From mechanical valve to the BioValsalva, world's first biological aortic conduit. Surg Technol Int, 2008, 17: 216-221.
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): 617-621,discussion 22.
5. Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg, 1993, 105(3): 435-438.
6. 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.
7. Shraer N, Youssefi P, Zacek P, et al. Bicuspid valve repair outcomes are improved with reduction and stabilization of sinotubular junction and annulus with external annuloplasty. J Thorac Cardiovasc Surg, 2022. [Epub ahead of print].
8. Schäfers HJ, Schmied W, Marom G, et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg, 2013, 146(2): 269-274.
9. Schneider U, Feldner SK, Hofmann C, et al. Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg, 2017, 153(4): S65-S71.
10. Salica A, Pisani G, Morbiducci U, et al. The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve. Eur J Cardiothorac Surg, 2016, 49(4): 1222-1227.
11. Hanke T, Charitos EI, Stierle U, et al. Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery. J Thorac Cardiovasc Surg, 2009, 137(2): 314-319.
12. Bilkhu R, Tome M, Marciniak A, et al. Does the aortic annulus dilate after aortic root remodeling? Ann Thorac Surg, 2020, 110(3): 943-947.
13. Devine K, Augoustides JG. Aortic valve repair: The evolving frontiers of aortic annuloplasty. J Cardiothorac Vasc Anesth, 2022, 36(11): 3999-4000.
14. Cabrol C, Cabrol A, Guiraudon G, et al. Treatment of aortic insufficiency by means of aortic annuloplasty. Arch Mal Coeur Vaiss, 1966, 59(9): 1305-1312.
15. Taylor W J, Thrower W B, Black H, et al. The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg, 1958, 35(2): 192-205 passim.
16. Federspiel JM, Ehrlich T, Abeln K, et al. Aortic annuloplasty: Subcommissural, intra-annular suture techniques, external and internal rings. JTCVS Tech, 2021, 7: 98-102.
17. Mazzitelli D, Fischlein T, Rankin JS, et al. Geometric ring annuloplasty as an adjunct to aortic valve repair: Clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg, 2016, 49(3): 987-993.
18. 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.
19. Schäfers HJ, Raddatz A, Schmied W, et al. Reexamining remodeling. J Thorac Cardiovasc Surg, 2015, 149(2 Suppl): S30-S36.
20. Seki M, Kunihara T, Takada J, et al. Comparison of hemodynamics and root configurations between remodeling and reimplantation methods for valve-sparing aortic root replacement: A pulsatile flow study. Surg Today, 2023, 53(7): 845-854.
21. De Kerchove L, Momeni M, Aphram G, et al. Free margin length and coaptation surface area in normal tricuspid aortic valve: An anatomical study. Eur J Cardiothorac Surg, 2018, 53(5): 1040-1048.
22. Oka T, Okita Y, Matsumori M, et al. Aortic regurgitation after valve-sparing aortic root replacement: Modes of failure. Ann Thorac Surg, 2011, 92(5): 1639-1644.
23. Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg, 2006, 132(2): 436-438.
24. Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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