Aortic Root Aneurysm Research Articles

The coupling between the aortic valve and root, left ventricular outflow tract, ascending aorta, and blood circulation is crucial for full valve function. Aortic root aneurysms and dissections are known to impair aortic valve function even in cases when the valve would otherwise function normally. A valve-conserving procedure, the Yacoub II Operation (YIIO), aims to restore normal physiology by tailoring the aortic root geometry to the patient. However, the relationship between root structure, particularly the sinuses, and valve function remains insufficiently characterized to determine to what degree surgeons should aim for a physiologically shaped sinus. This study presents the development of a computational Fluid-Structure Interaction (FSI) platform to investigate the biomechanical performance of the aortic valve-root complex. An idealized, parametric model of the aortic root, based on an ellipsoid design derived from healthy CT images, was created to systematically assess structure–function relationships. Simulation results demonstrated that geometric parameters, particularly the sinotubular junction (STJ) diameter and ascending aorta diameter significantly influence valve performance. Smaller STJ and ascending aorta diameters were associated with delayed valve opening and closure, prolonged valve open times, reduced maximum geometric and effective orifice areas, lower peak flow rates, and diminished maximum blood velocities. Sinus geometry itself had less of an effect on these outcomes. The developed FSI platform provides a predictive tool for aiding in surgical planning and outcomes in valve-conserving procedures such as the YIIO. Future work will focus on translating these findings to patient-specific models to enhance pre-operative assessment and long-term repair durability.

In silico assessment of aortic hemodynamic sensitivity to inlet boundary conditions: Comparative analysis of 4D MRI, patient-specific, and modified generic waveforms.

Reported outcomes in patients with bicuspid aortic valves (BAVs) undergoing valve-sparing aortic root replacement (VSRR) are scarce. This study aims to evaluate outcomes in patients with BAV using the reimplantation (David) technique. Consecutive adult patients with BAV, aortic root aneurysm, and/or aortic valve insufficiency (AI) undergoing VSRR (reimplantation) were included from 5 centers experienced in reimplantation procedures. Patients were subcategorized into 2 groups with different primary indications for operation: (1) aneurysm, and (2) isolated AI. Exclusion criteria included acute aortic dissection, endocarditis, and valvular-stenosis. In total, 498 patients were included. Mean age was 45.4 years (±11.8 years); median follow-up was 5.4 years (interquartile range, 2.3-8.7 years). Group 1 included aneurysm (n = 144) and group 2 included AI (n = 354). There was 1 in-hospital death. Survival (overall) was 93.4% (95% confidence interval [CI], 92-97%) at 10 years, with no difference between groups (P = .93) observed. Freedom from reintervention at 1 year was 99.1% (95% CI, 99%-100%), at 5 years 95.4% (95% CI, 93%-97%), and at 10 years 89.2% (95% CI, 86%-93%) for patients with aneurysm 100% at 1 year and 95.4% (95% CI, 92%-98%) at 10 years; and for AI 98.9% (95% CI, 98%-99%) at 1 year and 86.4% (95% CI, 83%-91%) at 10 years. Cusp fenestrations (P = .01), prolapse (P = .04), and isolated AI (0.03) were associated with greater hazard of reintervention. This multicenter study shows excellent results after VSRR reimplantation procedure in patients with BAV and aortic aneurysm and/or valve insufficiency. Isolated AI and cusp abnormalities are associated with greater reintervention rates and may reflect more advanced leaflet disease. The reimplantation technique, when performed in expert centers, appears to be an excellent treatment strategy in BAV.

ABSTRACT The Bentall procedure remains a reliable surgical solution for treating aortic root aneurysms in patients with Marfan syndrome. It significantly reduces the risk of catastrophic events such as rupture or dissection while offering durable and favorable long‐term results.

Abstract Background Patients with bicuspid aortic valve (BAV) often develop aortic root aneurysms. While aortic root replacement (Bentall procedure) has been the standard treatment for combined valvular and root pathology, valve-sparing root reimplantation (David procedure) has gained popularity for its potential to preserve the native valve and avoidance of prosthesis related complications. However, comparative data specific to patients with BAV and root aneurysm remain limited. Thus, we aimed to systematically compare the outcomes of the David and Bentall procedures in this anatomically and clinically distinct population. Methods A literature search was conducted in PubMed, Scopus, and Cochrane Library for studies comparing David and Bentall in patients with regurgitant BAV and aortic root aneurysm. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using RevMan 8.11.0. Results Four observational studies comprising 679 patients were included, of whom 252 (37.1%) underwent the David procedure. The David procedure was associated with significantly longer cardiopulmonary bypass (CPB) [MD 42.2 min; 95% CI 16.7 to 67.6; p = 0.001] and aortic cross-clamp (ACC) time [MD 50.8 min; 95% CI 22.8 to 78.8; p < 0.001]. However, due to extreme heterogeneity caution is warranted in interpreting these findings. The David procedure also demonstrated a statistically significant but clinically uncertain reduction in hospital length of stay [MD -1.4 days; 95% CI -2.7 to -0.1; p = 0.03] and re-explorations for bleeding [OR 0.4, 95% CI 0.1 to 0.9; p = 0.04]. Other postoperative outcomes, including stroke, arrhythmias, 30-day mortality, and ICU length of stay, were comparable between the two approaches. Conclusions The David procedure may be a viable option in selected BAV patients with root aneurysm. Despite longer CPB and ACC time, it is associated with shorter hospital stays and fewer re-explorations for bleeding, with similar rates of other postoperative outcomes. However, our findings should be interpreted with caution due to the retrospective design of the included studies, strong selection bias, and variability in patient characteristics and surgical techniques. Prospective, multicentre studies with extended follow-ups are needed to validate our results and better define the optimal surgical strategy in this population.

Single cell analysis identifies a distinct population of fibroblasts that mediate increased cell-cell communication in murine aortopathy of Loeys-Dietz syndrome.

The David procedure has been extensively studied as an elective treatment when valve anatomy and function permit valve-sparing aortic root replacement. This approach is particularly beneficial in young patients who also require mitral valve repair and treatment for mitral annular disjunction. This video tutorial provides a step-by-step guide to the David V procedure in a female patient with Marfan syndrome, presenting with an aortic root aneurysm, severe mitral regurgitation and mitral annular disjunction.

Concomitant aortic root and pulmonic root aneurysms secondary to giant cell arteritis are extremely rare. We present a case of a patient with giant cell arteritis who underwent concomitant valve-sparing aortic root replacement and valve-sparing pulmonary root replacement along with tricuspid valve repair.

Long-term survival and operative outcomes of the Bentall procedure for aortic root aneurysm, aortic dissection, and endocarditis.

AimsAortic valve-sparing root replacement is recommended over composite root replacement for aortic root aneurysms, especially in younger patients, but long-term outcomes in low-volume nationwide settings remain unclear. The objectives are to compare long-term survival, stroke, and reoperation rates between the two procedures in a low-volume national setting.Methods and resultsPatients were identified from the Western Danish Heart Registry and the Danish Heart Registry. Cases were validated by review of operative descriptions. The primary outcome was long-term survival from all-cause mortality; secondary outcomes included stroke, reoperation, recurrent aortic regurgitation, and aortic stenosis. Groups were balanced using propensity score matching. Echocardiographic data were provided for the matched cohort. We identified 760 patients treated with composite root replacement and 179 patients with aortic valve-sparing root replacement between January 2010 and April 2022. Mean follow-up was 6.5 years. Composite root replacement patients were younger [50.7 years (SD 14.1) vs. 55.2 (SD 13.5), P < 0.001], but more comorbid with a median EuroSCOREII of 5.5 [interquartile range (IQR): 3.3–11.7] vs. 3.4 (IQR: 2.6–5.0) (P < 0.001). After matching 157 patients per group, aortic valve-sparing root replacement showed improved 10-year survival [91.2%, 95% confidence interval (CI) 82.3–95.8 vs. 80.4%, 95% CI 70.0–87.5, log-rank P = 0.026], with lower 10-year stroke risk (4.9%, 95% CI 1.8–13.0 vs. 18.9%, 95% CI 11.7–29.9, log-rank P = 0.007). Risk of reoperation was nonsignificant (log-rank P = 0.12), which was consistent in the crude population when accounting for competing risk of death (log-rank P = 0.09).ConclusionIn this nationwide study, aortic valve-sparing root replacement was associated with better long-term survival and lower stroke risk, supporting its role as a durable surgical option for selected patients.

Annulus downsizing in valve-sparing aortic root replacement predicts aortic valve reoperation in children and young adults

Interruption of the aortic arch is a rare congenital cardiac malformation with rare cases described in adulthood. Survival in adulthood relies on developing collateral networks to maintain distal flow. CHD occurs in almost 50% of Turner syndrome and is the most frequent cause of early mortality. Also, they have an increased risk factor for thoracic aortic dilatation, and elective surgery should be considered according to body surface area. Surgical correction is the preferred treatment for the interrupted aortic arch and aortic root dilatation. We present the case of a 46-year-old patient with Turner syndrome with a diagnosis of interrupted aortic arch and aortic root aneurysm who underwent the Bentall procedure and interposition of a Dacron graft in the descending aorta. Post-procedural recovery was uneventful with a good haemodynamic response.

Personalized external aortic root support: The Dutch experience.

Safety and efficacy of the neo-modified cabrol procedure with cabrol-fistula in 469 patients with low coronary ostia aortic root aneurysm.

BackgroundValve-sparing root replacement (VSRR) is an alternative to traditional valve-replacing root replacement. We examined early- and mid-term outcomes after VSRR.MethodsWe performed a retrospective review of a prospectively maintained aortic registry. All patients undergoing VSRR from 2005 to 2023 were included. Statistical analysis was performed in R version 4.3.1. Kaplan–Meier curves were used to describe mortality and freedom from mortality, aortic insufficiency (AI) > 1 + , and aortic valve-related reoperation.ResultsEighty-one patients underwent VSRR, 59 (72.8%) through full sternotomy (FS) and 22 (27.2%) through upper hemisternotomy. There were no cases of AI > 1+ in the perioperative period, 1 (1.2%) stroke, and no in-hospital mortality. Mean intensive care unit and hospital stay were 3 and 7 days, respectively. Mean follow-up time was 8 years. Freedom from all-cause mortality at 1, 5, and 10 years was 100, 96.6, and 94.4%, respectively. Composite freedom from reoperation, recurrence, or mortality at 1, 5, and 10 years was 98.8, 92.1, and 87.3%, respectively.ConclusionWith careful preoperative selection, VSRR is a durable procedure for patients with aortic root aneurysm.

Background/Objectives: The Bentall procedure represents the gold standard therapy in patients with ascending aorta or aortic root aneurysm combined with aortic valve disease precluding a valve-sparing procedure. The aim of this study was to compare early and late outcomes in patients undergoing a Bentall procedure with either a biological or a mechanical valved conduit. Methods: All patients undergoing the Bentall procedure with either a biological or a mechanical valved conduit at our institution between 2001 and 2022 were retrospectively reviewed. A propensity-score (PS) matching analysis was performed to account for imbalances between the two groups. Clinical outcomes of interest included mortality and reintervention. Results: 548 patients underwent the Bentall procedure with a biological (n = 356, 65%) or a mechanical (n = 192, 35%) valved conduit during the study period. After PS-matching, two homogeneous groups of 154 patients were obtained, and no difference was observed in mean survival time between patients with mechanical Bentall and patients with biological Bentall (16 ± 0.8 vs. 16.3 ± 0.7 years, respectively; p = 0.72). Patients with a mechanical Bentall had a significantly higher mean survival time free from reintervention compared to patients with a biological Bentall (23.6 ± 0.4 vs. 21.4 ± 0.7 years, respectively, p = 0.02). PS-adjusted Cox regression showed that age >65 years, postoperative ECMO, and CVA were predictive risk factors of mortality. Conclusions: Bentall operation is a safe procedure for the treatment of ascending aorta and aortic root disease with good early and long-term survival and a low rate of reintervention. PS-matched analysis showed no difference in mortality between patients with a mechanical Bentall and patients with a biological Bentall; however, patients with a mechanical Bentall had a lower rate of reintervention.

Abstract Background Aortic valve replacement is one of the most common major cardiac surgeries worldwide, with various short- and long-term complications. Among these, prosthetic valve dehiscence, ranging from mild regurgitation to life-threatening severe paravalvular leaks, is one of the most catastrophic complications of prosthetic valves. Case presentation A hemodynamically stable 63-year-old patient with a history of two past cardiac surgeries due to aortic stenosis and aortic root aneurysm presented with dyspnea and coughing in the last 2 weeks. Fluoroscopy and transthoracic echocardiography revealed the aortic valve dehiscence after 40 years of the first surgery, and he underwent emergency redo surgery. A new mechanical valve replaced the aortic valve, and the aortic root remains intact. Although infectious and inflammatory conditions play an important role in late aortic valve dehiscence, in our patient, there was no evidence of either inflammation or infection. After surgery, patients recovered without any signs of complications. Conclusions This case highlights the complexity of diagnosing and managing late-onset prosthetic valve dehiscence. While often attributed to infection, chronic subclinical processes—such as progressive para-prosthetic leaks or annular degeneration—may silently progress and ultimately result in acute decompensation. Both infectious and noninfectious causes must be considered to ensure timely intervention and optimal outcomes.

Objective: To investigate the feasibility and clinical outcome of estimating the target length of the free margin of the leaflet by diameter of the prosthesis graft used to reconstruct the aortic root during the modified root remodeling procedure. Methods: This is a retrospective case series study. The clinical data of 11 patients with aortic root aneurysm who underwent modified aortic root remodeling procedure with external sub-valvular ring from July 2021 to May 2024 at Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College were analyzed. The age of the patients was (42.3±14.4) years (range:23 to 61 years), including 9 males and 2 females. The aortic valve of all patients was tri-leaflet configuration. Marfan syndrome was diagnosed in 3 cases. The diameter of the prosthesis graft was determined according to the Lansac group's criteria based on the diameter of the aortic annulus, and a graft ring of the same diameter was used as the external sub-valvular ring. The free margin of the leaflet was treated with central plication according to the standard of "target length of free margin of the leaflet=the diameter of the selected graft+3 to 5 mm". The surgical results and postoperative aortic valve closure function were observed. Results: All 11 patients successfully completed the operation without in-hospital death or complications. The graft with a diameter of 28 mm were used in 7 cases, 26 mm in 3 cases, and 30 mm in 1 case. 4 patients required central plication of the free margin of 3 leaflets, 2 patients required treatment of 2 leaflets, 3 patients required treatment of 1 leaflet, and 2 patients did not need treatment of the free margin of the leaflets. The functional status of aortic valve closure was significantly improved in all patients after surgery, and the degree of residual aortic regurgitation was not more than mild. After reconstruction of the aortic root, the measured effective height was (8.8±1.3) mm (range:7 to 11 mm) and the measured coaptation length was (5.2±0.9) mm (range:4 to 7 mm). All patients were re-examined 3 months after surgery. Echocardiography showed that the degree of aortic regurgitation was mild or lower, and the left ventricular end-diastolic diameter was (49.4±6.1) mm (range: 36 to 56 mm), which was smaller than that before the operation ((58.5±7.0) mm (range: 47 to 72 mm)). Eight patients were followed up for more than 6 months, and 5 patients were followed up for more than 1 year. The degree of aortic regurgitation in these patients was mild or below. Conclusions: The method based on the diameter of the selected prosthesis graft to deal with the length of the free margin of the leaflet can be effectively used in the modified aortic root remodeling procedure with external sub-valvular ring. The early postoperative results are satisfactory.

ABSTRACTMarfan syndrome predisposes individuals to severe cardiovascular complications, including aortic root aneurysms, with a high rupture risk. Timely diagnosis through advanced imaging and surgical intervention, such as the Bentall procedure, is essential. A high level of suspicion should be maintained for cardiovascular complications, even in young individuals with connective tissue disorders.

Cardiac computed tomography (CT) is an important tool in the management of patients with aortic root and ascending aorta dilatation. It complements echocardiography by providing high-resolution, three-dimensional images that enhance the assessment of aortic anatomy and help to determine the optimal timing for surgical intervention. Beyond preoperative planning, CT also plays an important role in postoperative surveillance by enabling early detection of changes or complications. Accurate imaging is essential for successful surgical outcomes, particularly given the complex structure of the aortic root and its relationship with the base of the left ventricle. Advances in CT technology, including improvements in spatial and temporal resolution, now allow surgeons to obtain highly detailed, accurate images of the aortic root, which are critical for planning aortic valve-sparing procedures. These detailed images provide a clearer picture of the root’s anatomy and structural components, thereby supporting more informed and precise surgical decision making. Intraoperative decision making based solely on surgical experience may always yield optimal results. This is because the aortic root is not under physiological stress during surgery, and outcomes may vary depending on the surgeon’s level of experience. These factors can influence the success of the procedure. This review highlights the growing importance of cardiac CT in the preoperative planning of complex aortic root surgeries. By providing clear, detailed anatomical data, CT enables surgeons to develop more individualized surgical strategies, ultimately improving outcomes and supporting personalized care for patients with aortic root aneurysms.