Root Reconstruction Research Articles

Surgical Management of Primary Pulmonary Artery Sarcoma

Primary pulmonary artery sarcoma is a rare cardiac tumor with a dismal prognosis without surgical therapy. It is often confused with the more common chronic pulmonary emboli which may delay the appropriate diagnosis or lead to suboptimal surgery. The objective of this study was to evaluate the short and long-term survival and local recurrence rate of pulmonary artery sarcoma cases operated on at our institution using an anatomic resection approach for the pulmonary trunk and main pulmonary arteries rather than endarterectomy. We searched our prospectively collected cardiac tumor database for cases of primary pulmonary sarcoma operated at our institution between June 2000 and September 2018 and followed until January 3, 2021. We used an anatomic resection and replacement technique for involved pulmonary root and main pulmonary arteries with endarterectomy used only for disease distal to the first arterial branch when lung preservation was possible. The primary endpoints for our study were survival from the time of initial diagnosis and survival from the time of our surgery. Secondary endpoints were operative 30-day mortality and incidence of local recurrence or metastatic disease. We identified 20 consecutive cases of surgical resection of primary pulmonary sarcoma. The median age at surgery was 52.5 years (IQR 43.5-60.5). Complete pulmonary root resection and reconstruction using a pulmonary homograft were needed in 16/20 (80%) of cases. All resections employed cardiopulmonary bypass with cardioplegic arrest. A pneumonectomy was needed in 7/20 (35%) of patients. A negative margin (R0) resection was achieved in 9 patients (45%) and margins were microscopically positive (R1) on final pathology in 9 patients (45%). Two patients (10%) had gross tumor (R2) at the resection margin. Operative mortality was 2/20 (10%). Median survival was 2.8 years from diagnosis (95% CI 1.3-8.8) and 2.7 years from surgery by our team (95% CI 0.8-5.9). Survival from first initial diagnosis at 1, 3, 5, and 10 years was 85.0%, 49.1%, 49.1%, and 16.4%. Survival from our surgery by our team at 1, 3, 5, and 10 years was 70%, 48.8%, 41.8%, and 8.4%. Surgical resection of primary pulmonary artery sarcoma with an approach utilizing an anatomic resection of the pulmonary root and main pulmonary arteries when involved and pneumonectomy or endarterectomy when there is disease distal to the first branch artery can be done with a reasonable operative risk and long-term survival when compared to the natural history of the disease.

Florida sleeve is a safe and effective technique for valve salvage in acute stanford type A aortic dissection.

Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute type-A aortic dissection (ATAAD). The Florida sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the FS repair in patients with dilated roots in the setting of an ATAAD. We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range, 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

Reinforced Aortic Root Reconstruction in Type A Aortic Dissection: A Prospective Study.

Type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Many techniques have evolved to repair the dissected sinus segments and restore aortic valve dynamics. Herein, we evaluate the early outcome of a novel technique for reconstruction of dissected aortic root. A prospective study was conducted on 300 patients to evaluate the early results of repair of dissected root in type A aortic dissection. The mean age was 59.65±8.52 years, and 76% of patients were males. All patients had four standard steps for aortic reconstruction: 1) commissural resuspension; 2) right coronary sinus reinforcement with pericardial and Dacron bands; 3) non-coronary sinus reinforcement using external Dacron patch; 4) circumferential inversion of adventitial layer of the root. Patients were followed up clinically, echocardiographically, and by CT scan. The in-hospital mortality was 8%. The mean cross-clamp time was 120±30 minutes, and circulatory arrest time was 25+10 minutes. Twenty-seven patients (9%) experienced postoperative complications, including bleeding and acute kidney injury. During a mean follow-up time of 48±12 months, there were no recurrent aortic dissection, aortic dilatation, pseudoaneurysm, or progression of aortic regurgitation during the entire study period. This reconstructive technique technically is undemanding, feasible, safe, and durable with good early results. A larger cohort of patients with longer period of follow up should generate a more powerful evaluation of this technique.

Effects of seasonal and climate variations on in-hospital mortality and length of stay in patients with type A aortic dissection

ObjectiveTo investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD).MethodsPatients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed.ResultsA total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS.ConclusionPatients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.

A modern approach to aortic valve insufficiency: Aortic root restoration via HAART 300 internal annuloplasty ring.

HAART 300 is an internal geometric annuloplasty ring. The safety and efficacy of this novel device in aortic valve (AV) repair in a single referral center are reported. Twenty patients with trileaflet AV insufficiency with ascending aorta and/or aortic root enlargement were included. Subannular implantation was performed to correct annular dilatation, whereas concomitant leaflet repair was performed whenever required. All but two patients also received ascending aorta replacement, whereas selective sinus replacement was performed in all but five patients. Follow-up was for a maximum of 3.8 years and a mean of 2.2 years. Mean age was 54.2 years old. Moderate to severe preoperative AV insufficiency was noted in 75% of patients, whereas 70% of them had an ascending aorta over 45 mm. One patient was lost from follow-up. Overall mortality as well as major complication rates were zero. Early postoperatively, no more than mild AV regurgitation was detected, whereas only one patient appeared with moderate AV regurgitation during our 2.2-year follow-up. New York Heart Association class was also significantly lower compared to preoperative values and valve gradients remained low at last follow-up. Geometric ring annuloplasty is a safe and effective valve sparing approach to deal with AV insufficiency contributing to overall root reconstruction. Short-term results are excellent rendering this easily reproducible and versatile method very attractive.

Combination Therapy of Chloramphenicol and Daptomycin for the Treatment of Infective Endocarditis Secondary to Multidrug Resistant Enterococcus faecium.

A 38-years-old female with an aortic valve replacement presented to an outside hospital (OSH) with fevers and malaise. Blood cultures revealed VRE which was resistant to linezolid, resistant to ampicillin, non-susceptible to daptomycin (MIC of 8 mcg/mL), and exhibited susceptibility to gentamicin. The patient was therefore initiated on intravenous (IV) daptomycin 6 mg/kg q24h and gentamicin IV 1 mg/kg q8h. However, after 14 days of therapy with daptomycin and gentamicin, the patient was transferred to our institution for the management of cardiogenic shock and hypoxemic respiratory failure. Given the concern for treatment failure, her antimicrobial regimen was changed to IV chloramphenicol 12.5 mg/kg every 6 hours with IV daptomycin 10 mg/kg every 48 hours given an estimated creatinine clearance of 30 mL/minutes. In vitro susceptibilities for chloramphenicol were performed which confirmed susceptibility. A transesophageal echocardiogram revealed a possible abscess at the left coronary cusp and aortic valve dehiscence. The patient underwent aortic valve replacement with aortic root reconstruction. The aortic valve culture grew VRE susceptible to linezolid but resistant to ampicillin and doxycycline. The patient was deemed clinically cured after 42 days of combination therapy with daptomycin and chloramphenicol. After 6 years of follow-up, the patient has not had a recurrent VRE infection. To our knowledge, this is the first case of endocarditis secondary to VRE that was successfully managed with the combination of daptomycin and chloramphenicol.

In situ Phenotyping of Grapevine Root System Architecture by 2D or 3D Imaging: Advantages and Limits of Three Cultivation Methods.

The root system plays an essential role in the development and physiology of the plant, as well as in its response to various stresses. However, it is often insufficiently studied, mainly because it is difficult to visualize. For grapevine, a plant of major economic interest, there is a growing need to study the root system, in particular to assess its resistance to biotic and abiotic stresses, understand the decline that may affect it, and identify new ecofriendly production systems. In this context, we have evaluated and compared three distinct growing methods (hydroponics, plane, and cylindric rhizotrons) in order to describe relevant architectural root traits of grapevine cuttings (mode of grapevine propagation), and also two 2D- (hydroponics and rhizotron) and one 3D- (neutron tomography) imaging techniques for visualization and quantification of roots. We observed that hydroponics tubes are a system easy to implement but do not allow the direct quantification of root traits over time, conversely to 2D imaging in rhizotron. We demonstrated that neutron tomography is relevant to quantify the root volume. We have also produced a new automated analysis method of digital photographs, adapted for identifying adventitious roots as a feature of root architecture in rhizotrons. This method integrates image segmentation, skeletonization, detection of adventitious root skeleton, and adventitious root reconstruction. Although this study was targeted to grapevine, most of the results obtained could be extended to other plants propagated by cuttings. Image analysis methods could also be adapted to characterization of the root system from seedlings.

Aortic Root and Pulmonary Artery Reconstruction in a Patient with Pulmonary Artery Intimal Sarcoma

Aortic Root and Pulmonary Artery Reconstruction in a Patient with Pulmonary Artery Intimal Sarcoma

Aortic root anatomy after aortic valve reimplantation

ObjectiveDuring the last decade, special concerns have been raised about the anatomic relationships among the sinotubular junction, ventricular-aortic junction, and virtual basal ring to improve the results of root reconstruction. The aim of this study is to evaluate the in vivo anatomy of the aortic root after reimplantation with the Valsalva graft and the anatomic relationship between its components. MethodsWe analyzed 10 consecutive patients with tricuspid aortic valves who underwent reimplantation with the Valsalva graft between September and December 2019. Surgical clips were applied as markers at the level of proximal annular knots and at the distal reimplanted commissures on the neo-sinotubular junction. Electrocardiogram-gated computed tomography scan of the aortic root was performed. Coordinates of the markers were exported on a 3-dimensional modeling software, and the distances between the virtual basal ring and the Dacron graft basal landmarks were measured. ResultsThe mean heights of Dacron graft basal landmarks from virtual basal ring were right-left commissure 7.1 ± 5.1 mm; right sinus 4.7 ± 4.1 mm; right-noncoronary commissure 2.8 ± 2.2 mm; noncoronary sinus 1.4 ± 1.6 mm; left-noncoronary commissure 2.2 ± 2.3 mm; and left sinus 2.0 ± 0.9 mm. The mean planar distances of basal Dacron graft landmarks from virtual basal ring (thickness) were right-left commissure 5.3 ± 3.1 mm; right sinus 2.8 ± 1.4 mm; right-noncoronary commissure 2.2 ± 1.5 mm; noncoronary sinus 1.5 ± 1.5 mm; left-noncoronary commissure 1.3 ± 1.0 mm; and left sinus 3.4 ± 2.5 mm. ConclusionsAfter reimplantation, despite a complete dissection of the root, slight asymmetry of graft proximal seating exists. The inner annuloplasty is on the virtual basal ring, and the proximal edge of the Dacron graft is on the ventricular-aortic junction at a slightly different thickness and height along the annular circumference. At the level of the right sinus and left/right commissure, the Dacron graft is higher than the virtual basal ring and the relative wall thickness is increased. The annular stabilization is unaffected.

Beh\xe7et\u2019s disease: successful aortic root reconstruction in severely dilated aortoventricular junction after aortic valve replacement with novel surgical method \u2013 case report

BackgroundBehçet’s disease is an auto-inflammatory disorder categorized as a primer systemic vasculitis of unknown aetiology. Genetic factors, infectious agents and the irregularity of T-cell homeostasis are presumed to be responsible for the emergence of Behçet’s disease. Characteristic symptoms are multisystemic. Although cardiovascular involvement is rare, it should be noted due to the difficulty of surgical treatment options.Case presentationOur 44-year-old male patient underwent aortic valve replacement due to aortic regurgitation. At the 15-month follow-up, echocardiography showed detachment of the prosthetic valve and in the aortic root, multiple pseudo-aneurysms were identified. We performed an aortic root reconstruction with a Bentall procedure using a special „skirted” conduit to reduce strain in the suture line between the conduit and the extremely dilated left ventricular outflow tract.ConclusionsThe surgical treatment of cardiovascular manifestations of Behçet’s disease remains challenging. This new technique may be beneficial in well-selected cases where the annulus of the aorta is extremely dilated or annular tissue disorder is present.

Valve-sparing operations on the aortic valve and the ascending aorta: radical correction of congenital and acquired heart diseases. Immediate outcomes

This paper presents the immediate outcomes of valve-sparing operations on the aortic valve and ascending aorta in radical correction of congenital and acquired heart disease. Materials and methods. The study enrolled 50 patients with aortic insufficiency who were operated upon at Shumakov National Medical Research Center of Transplantology and Artificial Organs from 2011 to 2019. The mean age was 48 ± 16 years, 64% of them were men (n = 32). The study included patients with tricuspid (n = 36, 72%) and bicuspid (n = 14, 28%) aortic valves. Aortic valve reimplantation was performed in 32 (64%) patients, aortic root remodeling - in 1 (2%). 17 (34%) patients had no aortic root reconstruction or remodeling. Aortic valve reimplantation was done in 4 (8%) cases in combination with coronary artery bypass grafting, and in 4 (8%) with mitral and tricuspid valve repair. Results. Thirty-day mortality was 0%. In 1 case (2%), a permanent pacemaker was installed due to complete atrioventricular block. There were no neurological and coronary events, and cases of endocarditis. In all patients (100%), aortic valve insufficiency after surgical correction did not exceed grade 1 according to echocardiographic follow-up examination. On aortic valve mean and peak gradients were 8 ± 6 and 15 ± 7 mm Hg, respectively. Findings. Type I and II valve-sparing reconstructive surgery (for bicuspid and tricuspid aortic valves) is an excellent alternative to prosthetic repair with great postoperative outcomes, low valve-associated complications and low mortality.

Valve-sparing aortic root reconstruction

This paper reviews the current main approaches to valve-sparing aortic root reconstruction. The advantages of valve-sparing surgeries are obvious - low mortality, longer survival, better quality of life of the operated patients, since the techniques save the heart's pumping reserves and free the patient from continuous intake of direct-acting oral anticoagulants and laboratory control of the hemostasis system, as well as other prosthesis-associated specific complications.

Mochica pronouns: their internal reconstruction and significance for worldwide patterns of paradigmatic resemblances in pronominal shapes

This article embeds an attempt at internal reconstruction of the pronominal roots of Mochica, an extinct language of the north coast of Peru, into broader comparative perspectives on the consonanti...

Meniscal Root Repair Along with Auxiliary Procedures for Joint Preservation: Current Concepts.

Meniscal root repair and joint preservation surgeries have gained increased interest in the last decade, from a better interpretation of the role of meniscal functions, from the biomechanical studies. Several published results from both biomechanical and clinical studies has proven the effectiveness of meniscal root repairs and has led to a unanimous international consensus for the need for root repair surgery. Meniscal repair by suture pull-out technique is widely followed around the world and leads to adequate healing and good clinical outcome. There are auxiliary procedures like centralization sutures (to reduce the meniscal extrusion), high tibial osteotomy, cartilage repair procedures,meniscal root reconstruction and ligament reconstructions areperformed along with meniscalroot repair, especially in the younger patients and recently sub-chondroplasty for the bone marrow lesions (BMLs)are also executed. This review article discusses the anatomy, types of root tears,evaluation, treatment, outcomes of root repair, and theneed for additional procedures, which areimperative for joint preservation and restoration of the biomechanics of the knee.

Data-Driven Regularization Parameter Selection in Dynamic MRI.

In dynamic MRI, sufficient temporal resolution can often only be obtained using imaging protocols which produce undersampled data for each image in the time series. This has led to the popularity of compressed sensing (CS) based reconstructions. One problem in CS approaches is determining the regularization parameters, which control the balance between data fidelity and regularization. We propose a data-driven approach for the total variation regularization parameter selection, where reconstructions yield expected sparsity levels in the regularization domains. The expected sparsity levels are obtained from the measurement data for temporal regularization and from a reference image for spatial regularization. Two formulations are proposed. Simultaneous search for a parameter pair yielding expected sparsity in both domains (S-surface), and a sequential parameter selection using the S-curve method (Sequential S-curve). The approaches are evaluated using simulated and experimental DCE-MRI. In the simulated test case, both methods produce a parameter pair and reconstruction that is close to the root mean square error (RMSE) optimal pair and reconstruction. In the experimental test case, the methods produce almost equal parameter selection, and the reconstructions are of high perceived quality. Both methods lead to a highly feasible selection of the regularization parameters in both test cases while the sequential method is computationally more efficient.

Assessing Fracture Resistance of non Vital Teeth Using Two Different Composite Systems: Short-Fibre-Reinforced Composite and Glass Fibre Post with Microfilled Hybrid Composite

Posterior endodontically treated teeth are exposed to risk fracture due to the great masticatory forces developed in the area. Fiberglass posts are considered a practical solution for such situations, but their main disadvantage yet remains the poor adhesion to the remaining tooth structures. The purpose of the present study was to evaluate a material that could replace the use of fiberglass posts on posterior teeth. 32 premolars were selected and divided into 4 groups (n=8): the first group was considered the control group; the second group was composed of endodontically treated teeth that were filled with gutta-percha, but without any coronal restoration; the third group was composed of teeth that received the same endodontic treatment as in the second group but were restored with a fibreglass post and a light cured microfilled hybrid composite material; the fourth group was similar to the third one, except teeth were restored with a short-fibre-reinforced composite (EverX Posterior, GC Europe N.V., Leuven, Belgium) and a microfilled hybrid composite over it. The fracture resistance of all the teeth was tested using a universal testing device. One-way ANOVA and the Tukey post-hoc variation tests for multiple comparisons were used to analyze the results. The short-fibre-reinforced composite material increased the fracture resistance of endodontically treated teeth (1159.42 N), twice as much as that obtained by using fiberglass posts (522.35 N)). Within the limitations of the present study, EverX Posterior represents a better alternative compared to fiberglass posts in the crown and root reconstruction of posterior endodontically treated teeth.

H-repair in supravalvular aortic stenosis.

H-repair in supravalvular aortic stenosis.

3D plant root system reconstruction based on fusion of deep structure-from-motion and IMU

Roots play a critical role in the functioning of plants. However, it is still challenging to generate detailed 3D models of thin and complicated plant roots, due to the complexity of the structure and the limited textures. Limited by the difficulty of realization and inaccessibility of labeled data for training, few works have been put in exploring this problem using deep neural networks. To overcome this limitation, this paper presents a structure-from-motion based deep neural network structure for plant root reconstruction in a self-supervised manner, which can be applied by mobile phone platforms. In the training process of deep structure-from-motion, each depth is constrained from the depth map and predicted relative poses from their adjacent frames captured by the mobile phone cameras, and the LSTM-based network after CNN for pose estimation is learnt from the ego-motion constraints by further exploiting the temporal relationship between consecutive frames. IMU unit in the mobile phone is further utilized to improve the pose estimation network by continuously updating the correct scales from the gyroscope and accelerometer moment. Our proposed approach is able to solve the scale ambiguity in recovering the absolute scale of the real plant roots so that the approach can promote the performance of camera pose estimation and scene reconstruction jointly. The experimental results on both real plant root dataset and the rendered synthetic root dataset demonstrate the superior performance of our method compared with the classical and state-of-the-art learning-based structure-from-motion methods.

Sufficient condition for root reconstruction by parsimony on binary trees with general weights

We consider the problem of inferring an ancestral state from observations at the leaves of a tree, assuming the state evolves along the tree according to a two-state symmetric Markov process. We establish a general branching rate condition under which maximum parsimony, a common reconstruction method requiring only the knowledge of the tree topology (but not of the substitution rates or other parameters), succeeds better than random guessing uniformly in the depth of the tree. We thereby generalize previous results of [13, 37]. Our results apply to both deterministic and i.i.d. edge weights.

Aortic Root Reconstruction with TachoSil Fibrin Sealant Patch in Acute Type A Aortic Dissection.

Purpose: We propose a novel technique for reconstruction of the dissected aortic root with the use of TachoSil fibrin sealant patch.Methods: Patients with acute type A aortic dissection involving the aortic root were included. Appropriately prepared TachoSil fibrin sealant patch was placed between the dissected layers of the aortic root to achieve their durable fusion. Thus, the false lumen was eliminated, and the anatomical and functional structure of the aortic wall was restored.Results: In all, 13 patients mean aged 57 ± 10.3 years underwent surgery for acute type A aortic dissection with the use of TachoSil fibrin sealant patch. All patients survived the surgery. The mean follow-up time was 30.8 ± 16.4 months. Follow-up computed tomography angiography (CTA) scans confirmed no aortic root dissection in all patients.Conclusions: This technique ensures durable restoration of the aortic wall structure, eliminates the secondary aortic valve regurgitation, and allows for the preservation of patients’ native aortic valve.