Florida sleeve repair for aortic insufficiency: A retrospective study in a single-center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Dongliang , LIU Shengchen ,  HUANG Fuhua

Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Jiangsu, 210006, P. R. China;

Corresponding author：

HUANG Fuhua, Email: huangfuhua@sina.cn

Keywords：

Valve-sparing aortic root replacement; aortic insufficiency; Florida sleeve procedure; aortic valvuloplasty

DOI：

10.7507/1007-4848.202407024

Video：

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Objective To summarize and analyze the surgical approach and early prognosis of repairing adult aortic closure insufficiency with the Florida sleeve procedure. Methods The patients with aortic insufficiency who underwent Florida sleeve repair in the First Hospital of Nanjing Medical University between August 2020 and May 2024 were selected. Their general data, perioperative conditions, and echocardiographic data before, during, and after the procedure and at follow-up were analyzed. Result Fifteen patients were included, consisting of 12 males and 3 females, aged 33-71 (53.5±12.4) years. Preoperative echocardiography indicated that there was 1 patient of rheumatic disease, 7 patients of degenerative disease, 4 patients secondary to aortic aneurysm, and 3 patients of bicuspid aortic valve. The severity distribution included 2 patients of severe insufficiency, 4 patients of moderate-to-severe insufficiency, 5 patients of moderate insufficiency, and 4 patients of mild-to-moderate insufficiency. The mean cardiopulmonary bypass time was (135.0±40.0) minutes, the aortic cross-clamp time was (109.9±38.6) minutes, and the median ICU stay was 1 day. No mortality was recorded within 30 days postoperatively. Follow-up echocardiography showed that the valve regurgitation, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and sinus diameter all achieved the desired outcomes. Conclusion Florida sleeve repair for aortic valve in patients with a sinus diameter less than 50 mm not only effectively improves hemodynamics in adults with aortic insufficiency, but also has the advantages of low surgical risk and rapid postoperative recovery, making it a promising procedure for clinical application.

1.	张玉玺, 冯乐乐, 陈城, 等. 主动脉瓣修复手术早中期结果及术后关闭不全的风险因素评估. 中国体外循环杂志, 2022, 20(2): 86-91.Zhang YX, Feng LL, Chen C, et al. Short and medium term outcomes and predictors of recurrent aortic regurgitation after aortic valve repair. Chin J ECC, 2022, 20(2): 86-91.
2.	宋磊, 赵雪松, 杨新卫. 主动脉瓣关闭不全治疗的研究进展. 中西医结合心脑血管病杂志, 2023, 21(12): 2218-2221.Song L, Zhao XS, Yang XW. Research progress in the treatment of aortic insufficiency. Chin J Integr Med Cardio-Cerebrovasc Dis, 2023, 21(12): 2218-2221.
3.	左煜, 黄强. 成人主动脉瓣关闭不全行主动脉瓣成形术研究现状. 心肺血管病杂志, 2022, 41(2): 206-209.Zuo Y, Huang Q. Current status of aortic valvuloplasty in adults with aortic insufficiency. J Cardiovasc Pulmon Dis, 2022, 41(2): 206-209.
4.	Furukawa K, Ohteki H, Cao ZL, et al. Does dilatation of the sinotubular junction cause aortic regurgitation? Ann Thorac Med, 1999, 68(3): 949-953.
5.	Roman MJ. Aortic root dilatation as a cause of isolated, severe aortic regurgitation. Ann Intern Med, 1987, 106(6): 800.
6.	侯倩文, 刘桂梅, 刘宁, 等. 主动脉根部扩张情况下窦部直径对瓣膜开闭性能的影响. 生物医学工程学杂志, 2019, 36(5): 737-744.Hou QW, Liu GM, Liu N, et al. Effect of sinus diameter on the opening and closing performance of aortic valve under the expansion of aortic root. J Biomed Eng, 2019, 36(5): 737-744.
7.	Katayama S, Umetani N, Sugiura S, et al. The sinus of Valsalva relieves abnormal stress on aortic valve leaflets by facilitating smooth closure. J Thorac Cardiovasc Surg, 2008, 136(6): 1528-1535. e1.
8.	Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: A new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750.
9.	孙立忠, 田良鑫, 常谦, 等. 保留主动脉瓣的主动脉根部替换术(David手术). 中华医学杂志, 2003, 83(09): 803-804.Sun LZ, Tian LX, Chang Q et al. Aortic root replacement with aortic valve retention (David operation). Natl Med J China, 2003, 83(9): 103-104.
10.	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 622.
11.	Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090.
12.	Aalaei-andabili SH, Martin TD, Hess PJ, et al. The Florida sleeve procedure is durable and improves aortic valve function. Aorta (Stamford), 2019, 7(2): 49-55.
13.	Freeman KA, Arnaoutakis GJ, Jeng EI, et al. Florida sleeve operative technique. Oper Tech Thorac Cardiovasc Surg, 2021, 26(2): 306-321.
14.	王世杰, 刘鹏, 温姝钰, 等. 主动脉瓣疾病手术治疗现状与进展. 临床心血管病杂志, 2023, 39(6): 417-424.Wang SJ, Liu P, Wen SY, et al. Current status and progress of aortic valve surgery treatment. J Clin Cardiol, 2023, 39(6): 417-424.
15.	潘荪, 王春生. PERIGON研究5年随访结果解读及外科主动脉瓣生物瓣置换的思考. 中国胸心血管外科临床杂志, 2023, 30(1): 17-24.Pan S, Wang CS, et al. Implications of five-year outcomes of PERIGON trial for bioprosthetic aortic valve replacement. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(1): 17-24.
16.	陆方林, 孙寒松, 徐学增, 等. 开拓进取谱华章—我国瓣膜性心脏病事业的发展与成就. 中国心血管病研究, 2021, 19(11): 961-965.Lu FL, Sun HS, Xu XZ, et al. The development and achievements of valvular heart disease in China. Chin J Cardiovasc Res, 2021, 19(11): 961-965.
17.	Hess PJ, Harman PK, Klodell CT, et al. Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms. Ann Thorac Surg, 2009, 87(4): 1161-1169.
18.	Gamba A, Tasca G, Giannico F, et al. Early and medium term results of the sleeve valve-sparing procedure for aortic root ectasia. Ann Thorac Surg, 2015, 99(4): 1228-1233.
19.	Tasca G, Selmi M, Votta E, et al. Aortic root biomechanics after sleeve and david sparing techniques: A finite element analysis. Ann Thorac Surg, 2017, 103(5): 1451-1459.
20.	Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2011, 41(1): 56-61.

1. 张玉玺, 冯乐乐, 陈城, 等. 主动脉瓣修复手术早中期结果及术后关闭不全的风险因素评估. 中国体外循环杂志, 2022, 20(2): 86-91.Zhang YX, Feng LL, Chen C, et al. Short and medium term outcomes and predictors of recurrent aortic regurgitation after aortic valve repair. Chin J ECC, 2022, 20(2): 86-91.
2. 宋磊, 赵雪松, 杨新卫. 主动脉瓣关闭不全治疗的研究进展. 中西医结合心脑血管病杂志, 2023, 21(12): 2218-2221.Song L, Zhao XS, Yang XW. Research progress in the treatment of aortic insufficiency. Chin J Integr Med Cardio-Cerebrovasc Dis, 2023, 21(12): 2218-2221.
3. 左煜, 黄强. 成人主动脉瓣关闭不全行主动脉瓣成形术研究现状. 心肺血管病杂志, 2022, 41(2): 206-209.Zuo Y, Huang Q. Current status of aortic valvuloplasty in adults with aortic insufficiency. J Cardiovasc Pulmon Dis, 2022, 41(2): 206-209.
4. Furukawa K, Ohteki H, Cao ZL, et al. Does dilatation of the sinotubular junction cause aortic regurgitation? Ann Thorac Med, 1999, 68(3): 949-953.
5. Roman MJ. Aortic root dilatation as a cause of isolated, severe aortic regurgitation. Ann Intern Med, 1987, 106(6): 800.
6. 侯倩文, 刘桂梅, 刘宁, 等. 主动脉根部扩张情况下窦部直径对瓣膜开闭性能的影响. 生物医学工程学杂志, 2019, 36(5): 737-744.Hou QW, Liu GM, Liu N, et al. Effect of sinus diameter on the opening and closing performance of aortic valve under the expansion of aortic root. J Biomed Eng, 2019, 36(5): 737-744.
7. Katayama S, Umetani N, Sugiura S, et al. The sinus of Valsalva relieves abnormal stress on aortic valve leaflets by facilitating smooth closure. J Thorac Cardiovasc Surg, 2008, 136(6): 1528-1535. e1.
8. Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: A new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750.
9. 孙立忠, 田良鑫, 常谦, 等. 保留主动脉瓣的主动脉根部替换术(David手术). 中华医学杂志, 2003, 83(09): 803-804.Sun LZ, Tian LX, Chang Q et al. Aortic root replacement with aortic valve retention (David operation). Natl Med J China, 2003, 83(9): 103-104.
10. 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 622.
11. Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090.
12. Aalaei-andabili SH, Martin TD, Hess PJ, et al. The Florida sleeve procedure is durable and improves aortic valve function. Aorta (Stamford), 2019, 7(2): 49-55.
13. Freeman KA, Arnaoutakis GJ, Jeng EI, et al. Florida sleeve operative technique. Oper Tech Thorac Cardiovasc Surg, 2021, 26(2): 306-321.
14. 王世杰, 刘鹏, 温姝钰, 等. 主动脉瓣疾病手术治疗现状与进展. 临床心血管病杂志, 2023, 39(6): 417-424.Wang SJ, Liu P, Wen SY, et al. Current status and progress of aortic valve surgery treatment. J Clin Cardiol, 2023, 39(6): 417-424.
15. 潘荪, 王春生. PERIGON研究5年随访结果解读及外科主动脉瓣生物瓣置换的思考. 中国胸心血管外科临床杂志, 2023, 30(1): 17-24.Pan S, Wang CS, et al. Implications of five-year outcomes of PERIGON trial for bioprosthetic aortic valve replacement. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(1): 17-24.
16. 陆方林, 孙寒松, 徐学增, 等. 开拓进取谱华章—我国瓣膜性心脏病事业的发展与成就. 中国心血管病研究, 2021, 19(11): 961-965.Lu FL, Sun HS, Xu XZ, et al. The development and achievements of valvular heart disease in China. Chin J Cardiovasc Res, 2021, 19(11): 961-965.
17. Hess PJ, Harman PK, Klodell CT, et al. Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms. Ann Thorac Surg, 2009, 87(4): 1161-1169.
18. Gamba A, Tasca G, Giannico F, et al. Early and medium term results of the sleeve valve-sparing procedure for aortic root ectasia. Ann Thorac Surg, 2015, 99(4): 1228-1233.
19. Tasca G, Selmi M, Votta E, et al. Aortic root biomechanics after sleeve and david sparing techniques: A finite element analysis. Ann Thorac Surg, 2017, 103(5): 1451-1459.
20. Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2011, 41(1): 56-61.

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