Aortic Root In Patients Research Articles

Deep-learning-based 3-dimensional Object Detection For Localization Of Aortic Root In Patients With Severe Aortic Stenosis

Deep-learning-based 3-dimensional Object Detection For Localization Of Aortic Root In Patients With Severe Aortic Stenosis

Management of severe aortic stenosis in the presence of an 8 mm right coronary stent protrusion

AbstractManagement of a protruding coronary stent into the aortic root in patients undergoing evaluation for transcatheter aortic valve replacement can be challenging. We describe a patient treated with stent trimming and surgical aortic valve replacement, highlighting the importance of a multidisciplinary evaluation and selection process in this complex scenario.

On the Material Constitutive Behavior of the Aortic Root in Patients with Transcatheter Aortic Valve Implantation

BackgroundTranscatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat patients with severe aortic valve stenosis. However, there is limited knowledge on the material properties of the aortic root in TAVI patients, and this can impact the credibility of computer simulations. This study aimed to develop a non-invasive inverse approach for estimating reliable material constituents for the aortic root and calcified valve leaflets in patients undergoing TAVI. MethodsThe identification of material parameters is based on the simultaneous minimization of two cost functions, which define the difference between model predictions and cardiac-gated CT measurements of the aortic wall and valve orifice area. Validation of the inverse analysis output was performed comparing the numerical predictions with actual CT shapes and post-TAVI measures of implanted device diameter.ResultsA good agreement of the peak systolic shape of the aortic wall was found between simulations and imaging, with similarity index in the range in the range of 83.7% to 91.5% for n.20 patients. Not any statistical difference was observed between predictions and CT measures of orifice area for the stenotic aortic valve. After TAVI simulations, the measurements of SAPIEN 3 Ultra (S3) device diameter were in agreement with those from post-TAVI angio-CT imaging. A sensitivity analysis demonstrated a modest impact on the S3 diameters when altering the elastic material property of the aortic wall in the range of inverse analysis solution.ConclusionsOverall, this study demonstrates the feasibility and potential benefits of using non-invasive imaging techniques and computational modeling to estimate material properties in patients undergoing TAVI.

Prophylactic effect of angiotensin receptor blockers in children with genetic aortopathies: the early bird catches the worm

AimsIn genetic aortopathies (GA) particular attention is paid to aortic root dilatation which has an impact on morbidity and mortality. This study focuses on the effects of therapy with angiotensin-II-receptor-blockers (ARB) or beta-blockers (BB) on aortic root growth and the question which therapy should be initiated at which dosage and at what age.MethodsSince 1998 we diagnosed 208 patients with GA (170 FBN-1). 81 patients between 5 months and 18 years receiving either ARB or BB therapy were included. We retrospectively analyzed the progression of the dilatation of Sinus Valsalva aortae (SV) using calculated z-scores before and after therapy initiation and compared BB and ARB treatment.ResultsBoth ARB and BB (p < 0.05) therapy showed significant improvement in aortic root growth, while the effect is significantly more pronounced in ARB (p < 0.01) independent of age and genetic cause. A detailed comparison of the two drug groups showed a more sustained effect in limiting the progression of the dilatation of the aortic root in patients treated with ARB. Progression of dilatation of the SV was significantly lower in children treated with ARBs compared to BB (delta z-score, p < 0.05). In addition, ARBs were better tolerated and had a significantly lower discontinuation rate (3%) compared to BB (50%) (p < 0.01). Independently of age at initiation all children and adolescents were able to reach the target dose under ARB.ConclusionWe demonstrated a significant change in both treatment options, with the effect of ARB being more pronounced while being better tolerated throughout the treatment period.

Cardiac Computed Tomography Angiography Anatomical Characterization of Patients Screened for a Dedicated Transfemoral Transcatheter Valve System for Primary Aortic Regurgitation

BackgroundCardiac computed tomography angiography was used to identify anatomical characteristics of the aortic root in patients with severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system. MethodsCardiac computed tomography angiography was performed prior to planned TAVR for 107 patients with severe AR and 92 patients with severe AS. Measurements related to aortic root and coronary artery anatomy were obtained and compared between groups. Perimeter >90 mm and aortic annulus angle ​>70 degrees were defined as the theoretical exclusion criteria for TAVR. A combination of sinus of Valsalva diameter <30 mm and coronary height <12 mm was defined as high risk for coronary occlusion. ResultsThe mean age of patients in the AR group was 74.9 ± 11.2 years, 46% were women, and the mean Society of Thoracic Surgeons risk score for mortality was 3.6 ± 2.1. Comparatively, the mean age of patients in the AS group was 82.3 ± 5.53 years, 65% were women, and the mean Society of Thoracic Surgeonsrisk score was 5.5 ± 3.3. Annulus area, perimeter, diameter, and angle were larger in patients with severe AR. Sinus of Valsalva diameters and heights were larger in patients with severe AR. More AR patients were excluded based on perimeter (14 vs. 2%) and annulus angle (6 vs. 1%). More AS patients exhibited high-risk anatomy for left main coronary occlusion (21 vs. 7%) and right coronary occlusion (14 vs. 3%). The maximum dimension of the ascending aorta was larger in patients with severe AR (39 vs. 35 mm). The percentage of referred AR patients with significant aortopathy requiring surgical intervention was very low (only 1 AR patient with ascending aorta diameter >5.5 cm). ConclusionsA significantly larger proportion of patients with severe AR are excluded from TAVR as compared to AS due to large aortic annulus size and steep annulus angulation. By far the most prevalent excluding factor is aortic annulus size, with fewer patients excluded due to angulation. AR patients have lower-risk anatomy for coronary occlusion. Larger transcatheter valve sizes and further delivery system modifications are required to treat a larger proportion of AR patients.

Abnormal aortic hemodynamics are associated with risk factors for aortic complications in patients with marfan syndrome.

It is difficult to assess the risk for aortic dissection beyond the aortic root in patients with Marfan syndrome (MFS). To aid risk assessment in these patients, we investigated aortic flow and wall shear stress (WSS) by 4D flow magnetic resonance imaging (MRI) in patients with MFS and compared the results with healthy volunteers. We hypothesized that MFS patients with a high-risk profile for aortic dissection would show abnormal hemodynamics in aortic regions associated with aortic dissection. MFS patients (n=55) and healthy subjects (n=25), matched for age and sex, prospectively underwent 4D flow MRI. 4D flow maps were constructed to detect elevated (defined as higher than the three-dimensional 95% confidence interval) and deviant directed (defined as vector angle differences higher than 120°) WSS in MFS patients as compared to the controls. Univariate and multivariate associations with risk factors for aortic dissection in MFS patients were assessed. The maximum incidence for elevated WSS was 20% (CI 9%-31%) and found in the ascending aorta. The maximum for deviant directed WSS was 39% (CI 26%-52%) and found in the inner descending aorta. Significantly more male patients had deviant directed WSS in the inner proximal descending aorta (63% vs 24%, p=0.014). Multivariate analysis showed that deviant directed WSS was associated with male sex (p=0.019), and a haplo-insufficient FBN1 mutation type (p=0.040). In 60% of MFS patients with a previous aortic root replacement surgery, abnormal hemodynamics were found in the ascending aorta. No significant differences between hemodynamics were found in the descending aorta between operated and non-operated patients. Deviant directed WSS in the proximal descending aorta is associated with known risk factors for aortic dissection in MFS patients, namely male sex and a haploinsufficient FBN1 mutation type.

D-2 | Cardiac Computed Tomography Angiography Anatomical Characterization of Patients with Primary Aortic Regurgitation

We sought to use cardiac computed tomography angiography (CCTA) imaging to identify anatomical characteristics of the aortic root in patients with primary severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system.

A New Look at Structural Changes in the Aortic Root in Aortic Valve Stenosis.

The dataset of computed tomography angiography prior to aortic valve replacement in 262 patients was analyzed. The mean age was 75.0±5.9 years. 99 (37.8±3.0%) men and 163 (62.2±3.0%) women took part in the study. The annulus fibrosus, sinotubular junction, and height of the sinuses of Valsalva were measured. In the tricuspid aortic valve group (n=251), in more than 50% of the cases, the diameter of the annulus fibrosus ranged from 23 to 26 mm. No significant association between the diameter of the annulus fibrosus and patient height (r=0.35; p=0.01) or body surface area (r=0.25; p=0.01) and the height of the sinuses of Valsalva (r=0.34; p=0.01) were revealed. Based on the ratio of the height of the sinuses of Valsalva and the diameter of the annulus fibrosus, three variants of the structure of the aortic root were identified: type A - K>1.05; type B- 0.95≤K≤1.05; type C- K<0.95. Type C of the aortic root was found to predominate in most cases, namely, in 98.0±0.9% (n=246).In the bicuspid aortic valve group (n=11), 2 patients had a type A of the aortic root, 1 patient had a type B, and 8 patients had a type C. A classification of variants of the aortic root structure has been proposed, which will be useful not only for practitioners when choosing a treatment method, but also for researchers to understand the structural characteristics of the aortic root in patients with its pathology.

Imaging characteristics and associations of left atrioventricular valve atresia and patent aortic root with isometric atrial appendages on multidetector CT.

The present study sought to study the imaging associations of left atrioventricular valve (mitral) atresia and patent aortic root in patients with isomerism of atrial appendages as detected on multidetector computed tomography (CT) angiography MATERIALS AND METHODS: The CT angiography studies performed at a tertiary medical center from January 2014 to December 2021 were retrospectively evaluated to identify patients with left atrioventricular valve atresia and patent aortic root with isometric atrial chambers. The morphology of the atrial appendage and extent of pectinate muscles was used to identify the type of isomeric atrial chambers. A comprehensive assessment of discordant arrangement of organs and the variations in venoatrial connections was done. Left atrioventricular valve atresia in the presence of patent aortic root and isomeric atrial appendages was identified in eight patients (four males). The mean age at diagnosis was 7 years. Right isomerism of the atrial appendages was seen in five patients while three patients had left isomerism. Disharmonious patterns of abdominal visceral arrangement were seen in two patients. Atrial and ventricular septal defects were seen in all patients. The most common pattern of ventricular arterial connection was DORV (double outlet right ventricle) (n = 4). While fivepatients had normally related great arteries, three had aorta anterior to the pulmonary trunk. Right ventricular outflow obstruction was seen in seven patients. Right aortic arch with mirror image branching was seen in four patients. Coronary artery anomalies were seen in four patients. The presence of left atrioventricular valve atresia and patent aortic root with isomeric atrial appendages is a rare congenital anomaly frequently associated with anomalous systemic and pulmonary drainage, conotruncal anomalies, and right ventricular outflow obstruction. Hence, comprehensive CT-based evaluation is indispensable in providing detailed anatomy and aids in presurgical planning.

Spontaneous thrombus formation in native aortic root in patients with hypoplastic left heart syndrome: clinical presentation, treatment, and outcomes.

We report a neonate who presented with spontaneous thrombus formation in the native aortic root after Norwood palliation for hypoplastic left heart syndrome. Thrombus formation led to myocardial ischaemia due to decreased coronary blood flow with electrocardiographic signs of ischaemia and elevated cardiac enzymes. Aggressive thrombolysis and anticoagulation therapy were major contributors to successful outcome.

Patient-Specific Computational Fluid Dynamics Reveal Localized Flow Patterns Predictive of Post-Left Ventricular Assist Device Aortic Incompetence.

Progressive aortic valve disease has remained a persistent cause of concern in patients with left ventricular assist devices. Aortic incompetence (AI) is a known predictor of both mortality and readmissions in this patient population and remains a challenging clinical problem. Ten left ventricular assist device patients with de novo aortic regurgitation and 19 control left ventricular assist device patients were identified. Three-dimensional models of patients' aortas were created from their computed tomography scans, following which large-scale patient-specific computational fluid dynamics simulations were performed with physiologically accurate boundary conditions using the SimVascular flow solver. The spatial distributions of time-averaged wall shear stress and oscillatory shear index show no significant differences in the aortic root in patients with and without AI (mean difference, 0.67 dyne/cm2 [95% CI, -0.51 to 1.85]; P=0.23). Oscillatory shear index was also not significantly different between both groups of patients (mean difference, 0.03 [95% CI, -0.07 to 0.019]; P=0.22). The localized wall shear stress on the leaflet tips was significantly higher in the AI group than the non-AI group (1.62 versus 1.35 dyne/cm2; mean difference [95% CI, 0.15-0.39]; P<0.001), whereas oscillatory shear index was not significantly different between both groups (95% CI, -0.009 to 0.001; P=0.17). Computational fluid dynamics serves a unique role in studying the hemodynamic features in left ventricular assist device patients where 4-dimensional magnetic resonance imaging remains unfeasible. Contrary to the widely accepted notions of highly disturbed flow, in this study, we demonstrate that the aortic root is a region of relatively stagnant flow. We further identified localized hemodynamic features in the aortic root that challenge our understanding of how AI develops in this patient population.

Residual root fate after aortic surgery in bicuspid aortic valve with right-to-left fusion: A comparative risk analysis.

Background and AimAlthough bicuspid aortic valve (BAV) anatomy might influence aortic aneurysm development, BAV‐related root involvement still lacks standardized surgical management. We aimed to evaluate late clinical outcomes and risk factors for root dilation after proximal aortic replacement in patients with BAV and right–left fusion (RL‐BAV).MethodsClinical and echocardiographic data of all patients with intraoperative RL‐BAV who underwent ascending aortic replacement with or without noncoronary sinus (NCS) replacement (Groups 1 and 2, respectively) between 1999 and 2017, were retrospectively revised. A multivariable analysis assessed hazard factors for root dilation during follow‐up (FU).ResultsOf 206 surgeries performed (M 81%; age: 57 ± 13 years, EuroSCORE II: 2.7 ± 1.9%), 79 (38%) required NCS replacement. One hundred fifty‐seven patients (76%) underwent aortic valve replacement (with aortic regurgitation predominating in Group 1, p = .04). The preoperative aortic root was larger in patients requiring NCS replacement (43.3 ± 5.1 vs. 39.2 ± 4.8 mm, p < .001). At a median FU time of 7 years (interquartile range: 4–10), no residual root dissections occurred, and only two patients (belonging to Group 2) required redo root surgery. Preoperative mild aortic regurgitation and aortic root diameter >35 mm at discharge were risk factors for root dilation >40 mm at FU (p = .02). Aortic root did not dilate over time, irrespective of NCS replacement (p = .06).ConclusionsAortic root in patients with RL‐BAV undergoing ascending aortic replacement (±NCS replacement) does not significantly dilate over time, even if patients with preoperative aortic regurgitation and postoperative root more than 35 mm might require more surveillance.

Bicuspid aortic valve flow dynamics using blood speckle tracking in children

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Labatt Family Heart Centre Background Bicuspid aortic valves (BAV) are the most common form of congenital heart disease with a prevalence of up to 2%. Fusion of the aortic cusps result in complex flow patterns in the aortic root which may contribute to the risk of progressive dilation. Imaging these patterns with conventional echocardiography is challenging due to the angle dependency of colour Doppler. Blood speckle tracking (BST) is a novel method based on high-frame rate ultrasound that is less angle-independent and developed to evaluate complex flow. Purpose The aims of this study were to 1) describe and quantify flow patterns in the aortic root using blood speckle tracking and 2) quantitatively compare flow parameters (energy loss, vorticity, kinetic energy) between paediatric patients with BAVs and those with normal aortic valves. Methods Clinical and routine echocardiographic parameters were collected for children with normal and BAVs. Children were imaged using a commercially available clinical scanner with research software enabling the acquisition of high-frame rate imaging and blood speckle tracking. Aortic root energy loss, vorticity and kinetic energy were measured in the parasternal long axis view. Results Data from 46 patients were analyzed (31 normal aortic valves, 15 BAVs) with no significant difference in age, height, weight or BSA between groups. Nine patients (60%) had right-left fusion; 6 (40%) had right-non fusion. Qualitative flow assessment in aortic root demonstrated disturbed flow in the BAV group (see figure) generally directed towards the non-fused cusp (i.e non coronary cusp in right-left fusion). Patients with a BAV had higher aortic valve peak velocity (2.1 m/s vs 0.9 m/s, p&amp;lt; 0.001); aortic root systolic energy loss (4.29 mW/m vs 1.79 mW/m, p&amp;lt; 0. 001), vorticity (38.7 1/s vs 31.1 1/s, p&amp;lt; 0.01) and kinetic energy (34.5 mJ/m vs 24.5 mJ/m, p = 0.04) compared to those with normal aortic valves. Conclusion(s) Blood speckle tracking can demonstrate altered flow patterns in the aortic root in patients with BAV. These patients have increased energy losses, vorticity and kinetic energy when compared to age matched patients with normal aortic valves however the relationship of theses parameters to aortic root dilation remains to be demonstrated. Abstract Figure. Flow patterns (A-C) and analysis (D-F)

Assessment of serum phenylalanine and tyrosine isomers in patients with ST-segment elevation vs non-ST-segment elevation myocardial infarction.

BackgroundUnder conditions of oxidative stress, hydroxyl radicals can oxidize phenylalanine (Phe) into various tyrosine (Tyr) isomers (meta‐, ortho‐, and para‐tyrosine; m‐, o‐, and p‐Tyr), depending on the location of the hydroxyl group on the oxidized benzyl ring. This study aimed to compare patients with ST‐segment elevation myocardial infarction (STEMI) and non‐STEMI (NSTEMI) and the serum levels of Phe and Tyr isomers at the aortic root and distal to the culprit lesion in both groups.MethodsForty‐four patients participated in the study: 23 with STEMI and 21 with NSTEMI. Arterial blood samples were taken from the aortic root through a guiding catheter and from the culprit vessel segment distal from the primary lesion with an aspiration catheter, during the percutaneous coronary intervention. Serum levels of Phe, p‐Tyr, m‐Tyr, and o‐Tyr were determined using reverse‐phase high‐performance liquid chromatography.ResultsSerum levels of Phe were significantly higher distal to the culprit lesion compared to the aortic root in patients with STEMI. Serum p‐Tyr/Phe and m‐Tyr/Phe concentration ratios were both lower distal to the culprit lesion than at the aortic root in patients with STEMI. There were no statistically significant differences with respect to changes in serum Phe and Tyr isomers distal to the culprit lesion compared to the aortic root in patients with NSTEMI.ConclusionOur data suggest that changes in serum levels of different Tyr isomers can mediate the effects of oxidative stress during myocardial infarction.

Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis

The ideal surgical reconstruction of the aortic root in patients with complex endocarditis is controversial. We compared the short- and long-term outcomes between mechanical valves, bioprostheses, and homografts. We identified all patients undergoing an operation for active complex aortic endocarditis at our institution between 2003 and 2017. We grouped patients according to those who received a mechanical valve, bioprosthesis, or homograft. We used multiple logistic regression and proportional hazards models. To minimize confounding by indication, we used marginal risk adjustment to simulate that every patient would undergo (contrary to fact) all 3 operations. Of 159 patients with complex active endocarditis, 48 (30.2%) had a valve plus patch reconstruction, and 85 (53.4%) had a root replacement. Of all, 50 (31.5%) had a mechanical valve, 56 (35.2%) had a bioprosthesis, and 53 (33.3%) had a homograft. The groups were similar in age, sex, body mass index, comorbid conditions, organism, abscess location, and mitral involvement (all P > .05). However, patients receiving mechanical reconstructions were more likely to have native valve endocarditis (46% vs 37.5% vs 17%; P= .005) and less likely to undergo root replacement (32% vs 28.6% vs 100%; P < .001). Marginal risk-adjusted operative mortality was lowest for mechanical valves (4.8%) and highest for homografts (16.9%; P= .041). Long-term survival after root replacement was worse with homografts than with mechanical valve conduits (adjusted hazard ratio, 2.9; P= .045). In patients with complex endocarditis, mechanical valves are associated with similar, if not better, short- and long-term outcomes compared with homografts, even after adjusting for important baseline characteristics and limiting the analysis to root replacements only.

Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous-flow left ventricular-assist device support.

Severe aortic insufficiency (AI) after implantation of continuous-flow left ventricular-assist device (LVAD) affects device performance and outcomes. However, the mechanism for the occurrence and progression of AI has not been elucidated. We investigated the impact of nonphysiological retrograde blood flow in the aortic root on AI after LVAD implantation. Blood flow pattern was analyzed in patients with and without AI (n = 3 each) who underwent LVAD implantation, by computational fluid dynamics with patient-specific geometries, which were reproduced using electrocardiogram-gated 320-slice computed tomographic images. The total volume of retrograde blood flow during one cardiac cycle (716±88 mL) was higher and the volume of slow blood flow (<0.1 cm/s) (0.16 ± 0.04cm3 ) was lower in patients with AI than in those without AI (360 ± 111 mL, P =.0495, and0.49 ±0.08 cm3 , P =.0495, respectively). No significant difference in wall shear stress on the aortic valve was observed between the groups. Patients with AI had a perpendicular anastomosis at the distal ascending aorta and the simulation in the modified anastomosis model of patients with AI showed that the retrograde blood flow pattern depended on the angle and position of anastomosis. Computational fluid dynamics revealed strong retrograde blood flow in the ascending aorta and aortic root in patients with AI after LVAD implantation. The angle and position of LVAD outflow anastomosis might impact retrograde blood flow and de novo AI after LVAD implantation.

Management of Dilated Aortic Root in Patients Undergoing Repair of Acute Type-A Aortic Dissection

Management of Dilated Aortic Root in Patients Undergoing Repair of Acute Type-A Aortic Dissection

Increased aortic stiffness index in patients with type 1 diabetes without cardiovascular disease compared to controls.

Increased arterial stiffness is an early sign of endothelial dysfunction. Nevertheless, measures of the elastic properties of the aortic root in patients with type 1 diabetes are still lacking. The aim of this study was to compare aortic root stiffness index in type 1 diabetes and healthy controls. Ninety-three patients with type 1 diabetes without cardiovascular diseases were recruited and compared to 33 healthy controls. Aortic root elastic properties were estimated by measuring the systolic and diastolic diameters on M-mode acquisition. None of the subjects showed alterations of either systolic or diastolic echocardiographic parameters. Patients with type 1 diabetes had a very low prevalence of chronic complications and their metabolic control was good. Significantly increased aortic stiffness index was found in type 1 diabetes compared to controls, and the same different pattern was found in men and women. The presence of type 1 diabetes and increased pulse pressure was significantly associated with aortic stiffness index in a multivariate linear analysis. This study strongly suggests that patients with type 1 diabetes develop aortic root stiffness in the absence of cardiovascular diseases. This alteration may be part of a more generalized arterial dysfunction in type 1 diabetes.

Determinants of Peripheral Pulse Pressure and Pulse Pressure Amplification

ObjectivePeripheral (e.g. brachial) Pulse Pressure (Ppp) exceeds central pulse pressure (Cpp) corresponding to the first (Cpp1) or second (Cpp2) peaks in the central waveform. This pulse pressure amplification, attributed to propagation of the pulse wave from aorta to periphery and influence of reflection in the periphery, is measured as Ppp/Cpp2 (when Cpp2 > Cpp1). We examined whether the haemodynamic determinant of Ppp relates more closely to Cpp1 rather than Cpp2.MethodsWe examined the theoretical influence of change in morphology of central aortic waveform on peripheral waveform when applying a reverse transfer function to the aortic waveform. Secondly, we examined the relationship between central and peripheral waveforms during modulation of central pressure with nitroglycerine (GTN). Central pressures were obtained during cardiac atheterization with a Millar catheter placed in the proximal aortic root in patients with non-critical coronary artery disease (n = 15) at baseline and after GTN. The digital arterial pulse was acquired simultaneously with a servo-controlled finger cuff.ResultsIn theoretical analysis, Ppp was sensitive only to the portion of the waveform up to the time of Cpp1. Similar results were observed with GTN, which had no significant effect on Cpp1 (38.7 ± 2.0 and 37.1 ± 2.5 mmHg at baseline and after GTN respectively, P = 0.36) nor on Ppp (70.2 ± 5.0 and 69.2 ± 4.7 mmHg at baseline and after GTN respectively, P = 0.47) but reduced Cpp2 by 17.0 ±1.8 mmHg (P < 0.001).ConclusionsThese results suggest that peripheral pulse pressure is determined by the early systolic portion of the central aortic pressure waveform up to the time of Cpp1 and may be independent of Cpp2.

OC78 THE ROLE OF CORONARY SINUS-SPARING TECHNIQUE FOR TREATMENT OF AORTIC ROOT ANEURYSM IN PATIENTS WITH BICUSPID AORTIC VALVE: PRELIMINARY LONG-TERM FOLLOW UP RESULTS

Background and Aim: to analyze late outcomes and fate of aortic root in patients with bicuspid aortic valve with antero-posterior orientation (BAV-AP) and aortic dilation undergoing ascending aorta replacement extended to the non-coronary sinus (NCS) (coronary-sinus sparing technique). Methods: clinical and echocardiographic data of patients with BAV-AP scheduled for ascending aorta and root aneurysm repair and undergone ascending aorta replacement with coronary sinus-sparing technique at a single Center between 2000 and 2013 were retrospectively reviewed. Patients undergone redo operations or emergent surgery were excluded. Results: 69 patients (males n = 63, median age 66 years, IQ range 48–66) underwent coronary-sinus sparing technique: 50 (72%) required associated aortic valve replacement. There were no hospital deaths. Only 1 major postoperative bleeding requiring reintervention happened. At 15-years follow up (completeness 96%), 13 (19%) patients died, but only 4 (6%) due to cardiovascular deaths. Only 6 (9%) patients underwent cardiac reoperation (none for root dilation). No aortic dissections occurred. At follow up all patients are in good clinical status with only 7 (10%) patients with NYHA II-III. Echocardiographic analysis of available data showed significant reduction of root diameter after intervention, with slightly increase at follow up (Figure 1). Conclusions: coronary sinus-sparing technique with ascending aorta replacement extended to NCS in patients scheduled for aortic aneurysm repair with BAV-AP and asymmetrical root enlargement is a safe and low risk procedure, with good results in terms of late survival and freedom from root reintervention. This procedure reduces preoperative root diameter, granting nearly stable results at long-term follow up.