Total root replacement (TRR) with a valved conduit has long been the treatment standard for most aortic root diseases. However, with advances in technology and a deeper understanding of aortic root anatomy and hemodynamics, valve-sparing aortic root replacement (VSRR) and personalised external aortic root support (PEARS) have emerged. It is especially important to choose the appropriate procedure for different aortic root diseases. When evaluating these three surgical procedures, it is necessary to focus on the treatment and prevention of the dissection and balance the short-term and long-term risks of the patients. This article outlines aortic-related diseases and the selection of surgery.
ObjectiveTo evaluate the feasibility and safety of modified Yacoub technique with aortic annuloplasty in the patients with aortic root aneurysm and dilatation of aortic annular base.MethodsWe performed a retrospective review of 6 patients with aortic root aneurysm undergoing modified Yacoub technique with aortic annuloplasty from November 2017 to January 2019. There were 5 males and 1 female, with a mean age of 54.1±12.3 years. The preoperative cardiac function of 3 patients was in New York Heart Association (NYHA) classⅡand the other 3 patients were in class Ⅲ. There were two patients with bicuspid aortic valve, and no Marfan syndrome. There was aortic regurgitation in the patients measured by the echocardiogram, 1 in mild aortic regurgitation, 1 in moderate aortic regurgitation, and 4 in severe aortic regurgitation. The diameter of aortic annular base was 27.8±1.9 mm, and the largest diameter of aortic root was 49.8±3.7 mm. Six patients underwent modified Yacoub technique with aortic annuloplasty, including 5 patients who underwent aortic cusp repair at the same time.ResultsAll 6 identified patients survived. There was no severe complication (bleeding, stroke, or acute renal failure). The cardiopulmonary bypass time was 204.6±13.5 min, aortic cross-clamping time 168.0±17.1 min, mechanical ventilation time 21.3±19.5 h, ICU stay time 67.8±62.2 h. The follow-up time ranged from 4 to 18 months with an average time of 12.8±4.7 months. Patients' cardiac function improved postoperatively with four patients in NYHA classⅠand two patients with classⅡ. Two patients had no aortic valve regurgitation, four patients had mild regurgitation. Left ventricular end diastolic volume decreased significantly (118.6±20.4 mL vs. 169.1±58.4 mL, P<0.05).ConclusionThe modified Yacoub technique with aortic annuloplasty is effective and safe for the patients with aortic root aneurysm and dilatation of aortic annular base, and the early- and mid-term outcomes are satisfactory.
ObjectiveTo evaluate the midterm effect of valve-sparing aortic root replacement (VSRR) on aortic root aneurysm and moderate to severe aortic regurgitation (AR). MethodsThe clinical data of patients with aortic root aneurysm and moderate to severe AR undergoing VSRR and surviving from the operation from October 2013 to May 2020 were retrospectively analyzed. There were 31 males and 9 females, with an average age of 47.1±13.4 years. There were 30 patients with true aneurysm of aortic root and 10 patients with dissecting aneurysm of aortic root. There were 3 patients with bicuspid aortic valve, and 12 patients with Marfan syndrome. The AR measured by the echocardiogram was moderate in 18 patients and severe in 22 patients. The average diameter of aortic annulus was 27.0±3.9 mm, and the mean largest diameter of aortic sinus was 52.3±6.1 mm. ResultsA total of 32 patients underwent David technique and 8 patients underwent Yacoub technique, and 10 patients underwent aortic cusp repair simultaneously. All 40 patients completed the follow-up, and the follow-up period was 12-86 (45.7±18.9) months. During the period, 1 patient died of heart failure, 2 had reoperation due to new-onset Stanford B aortic dissection, and no patients had reoperation related to aortic valve. The postoperative New York Heart Association cardiac function classification (1.6±0.5 vs. 2.8±0.8), left ventricular end-diastolic dimension (52.2±7.8 mm vs. 61.4±10.6 mm) and left ventricular end-diastolic volume (136.0±58.8 mL vs. 193.3±83.9 mL) of the patients were significantly improved compared with preoperative ones (P<0.05). By echocardiography, 19 patients had no AR, 18 patients had mild AR, 3 patients had mild-moderate AR, and no patients had moderate or higher AR. ConclusionIn patients with aortic root aneurysm and moderate to severe AR, VSRR technique avoids prosthetic valves and anticoagulation-related complications, has lower rate of AR recurrence and reoperation, and improves the quality of life in the midterm period.
ObjectiveTo evaluate the feasibility and safety of Remodeling+Ring (modified Yacoub) for patients with aortic root aneurysm. MethodsThe 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. ResultsFour 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. ConclusionModified Yacoub technique is safe and effective for patients with aortic root aneurysm.