Aortic Root Reconstruction Research Articles

Use of the variable-length intraluminal sutureless graft

From August 1987 to May 1988 we treated 4 patients with acute ascending aortic dissections with a variable-length intraluminal aortic prosthesis. This operation uses profound hypothermic circulatory arrest and represents a refinement of existing techniques. There was no mortality, and morbidity was minimal. Modifications of this technique can be used in performing proximal aortic root reconstruction with a composite valved conduit. The use of a variable-length intraluminal prosthesis and hypothermic circulatory arrest is illustrated. This is a safe and useful technique in select cases of acute ascending aortic dissection.

Toward a durable and safe aortic root reconstruction

The development of acceptable and durable aortic root operations has been interesting. With trial and error there has been a progressive intrusion on the aortic valve and coronary arteries. Many surgeons have contributed to this progression, with the final step being taken by Dr Bentall in 1968. Since that time has come a gradual application of this more complete operation and a better understanding of its advantages.

大動脈弁逆流を伴う上行大動脈りゅうに対するｉｎｃｌｕｓｉｏｎ ｔｅｃｈｎｉｑｕｅを用いない大動脈基部再建法

大動脈弁逆流を伴う上行大動脈りゅうに対するｉｎｃｌｕｓｉｏｎ ｔｅｃｈｎｉｑｕｅを用いない大動脈基部再建法

解離性大動脈りゅうに対する手術術式の工夫 急性Ａ型大動脈解離の根治的大動脈基部再建術

解離性大動脈りゅうに対する手術術式の工夫 急性Ａ型大動脈解離の根治的大動脈基部再建術

Viable Cryopreserved Aortic Homograft for Aortic Valve Endocarditis and Annular Abscesses

Six consecutive patients with active aortic valve endocarditis, including 2 with extensive subannular aortic root abscess, were successfully treated with viable cryopreserved homograft aortic valve replacement. Two patients required extensive aortic root reconstruction with an appropriately trimmed aortic homograft to cover large abscess cavities. All patients showed resolution of infection with no perioperative mortality or clinically significant morbidity. Three patients had a minor degree of aortic insufficiency on postoperative echo-Doppler study. On follow-up at 6 to 48 months, all patients were in New York Heart Association functional class I. The resistance of the unstented homograft to infection makes it an attractive choice for patients requiring aortic valve replacement for active endocarditis. The results of surgical intervention in patients with extensive aortic root involvement may be further improved by the flexibility afforded by the homograft to be "custom-fit" to the abnormal aortic root and the ability to achieve secure abnormal aortic root and the ability to achieve secure valve fixation without use of prosthetic material.

Congenital aortic stenosis with hypoplasia of the left sinus of Valsalva: Anatomic reconstruction of the aortic root

Evaluation of the aortic root in 13 patients with congenital aortic stenosis aged 2.5 to 24 years (mean 8.3 years) has revealed morphologic characteristics of asymmetry of the aortic root caused by a small (hypoplastic) left sinus of Valsalva associated with a supravalvular ridge above the left coronary ostium and dysplasia of the aortic valve. The asymmetry resulted in folding and buckling of the left aortic cusp. The aortic valve was classified as bicuspid in 11 of the 13 patients. Preoperative aortography was characteristic and revealed the diagnosis in all patients. The average left ventricle-aorta systolic pressure gradient was 81 mm Hg. Operative repair consisted of an oblique aortotomy extended in a spiral fashion to the right and posteriorly into the left sinus of Valsalva. Seven patients had further mobilization of the posterior commissure with a second incision to the right of the commissure into the noncoronary sinus. Slightly fused valve commissures were opened in 12 patients. Aortic root reconstruction was accomplished with a spiral Dacron patch and posterior commissural repositioning. Follow-up catheterization at 9 to 35 months (mean 24 months) in five patients demonstrated an average outflow tract systolic gradient of 28 mm Hg and a more symmetrical appearance of the aortic root.

Plastic reconstruction of the aortic root for the relief of congenital supra valvular aortic stenosis: Postoperative evaluation

Plastic reconstruction of the aortic root for the relief of congenital supra valvular aortic stenosis: Postoperative evaluation