Integrating resuspension with remodeling: Early results with a new valve-sparing aortic root reconstruction technique
Andras C. Kollar, Scott D. Lick, Vincent R. Conti
Background and aim of the study: Currently, two different valve-sparing aortic root reconstruction methods are utilized, namely reimplantation and remodeling. Herein are reported the authors' early results with a new technique that integrates the two procedures. Methods: Seven patients (age range: 25-69 years) underwent valve-sparing aortic root replacement with a new technique that integrates the principles of the David and Yacoub operations. The preoperative aortic root sizes were 4.9 to 7.0 cm, and six patients had aortic regurgitation (grade 1+ to 3+). Surgery was divisible into four stages: (i) External subcommissural (downsizing) annuloplasty; (ii) graft sizing and valve competency assessment with saline squirt test; (iii) sewing the individual tongues of a hand-scalloped Hemashield graft to the annular tissue with subvalvular pledgeted mattress sutures; and (iv) running suture lines to the commissural aspects of the aortic wall, followed by coronary reimplantation. Results: All patients survived surgery. Intraoperative transesophageal echocardiography showed trace aortic incompetence (AR) in five patients, and mild or moderate AR each in one patient. Over a two-year period the technique was improved to the above-described, four-stage approach, which resulted in only trace AR in the final three patients. Early serial transthoracic echocardiography confirmed stable root dimensions and no progression of AR, except in an early patient. Conclusion: In the described technique, graft sizing is strictly tied to early intraoperative valve competency testing after an initial reconstruction within the native aortic root. The operation is then converted into a modified remodeling by suturing the triple-tongued (Yacoub) graft to the true aortic annulus with subannular pledgets (David principle). The operation involves significantly less dissection around the aortic root, and the entire scalloped annulus is stabilized in between the graft material and pledgets.
Journal of Heart Valve Disease
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Aortic Valve Medicine & Life Sciences 100%
Aortic Valve Insufficiency Medicine & Life Sciences 85%
Transplants Medicine & Life Sciences 45%
Replantation Medicine & Life Sciences 34%
Sutures Medicine & Life Sciences 26%
Transesophageal Echocardiography Medicine & Life Sciences 16%
Dissecting Aneurysm Medicine & Life Sciences 16%
Tongue Medicine & Life Sciences 13%
Kollar, A. C., Lick, S. D., & Conti, V. R. (2008). Integrating resuspension with remodeling: Early results with a new valve-sparing aortic root reconstruction technique. Journal of Heart Valve Disease, 17(1), 74-80.
Integrating resuspension with remodeling : Early results with a new valve-sparing aortic root reconstruction technique. / Kollar, Andras C.; Lick, Scott D.; Conti, Vincent R.
In: Journal of Heart Valve Disease, Vol. 17, No. 1, 01.01.2008, p. 74-80.
Kollar, AC, Lick, SD & Conti, VR 2008, 'Integrating resuspension with remodeling: Early results with a new valve-sparing aortic root reconstruction technique', Journal of Heart Valve Disease, vol. 17, no. 1, pp. 74-80.
Kollar AC, Lick SD, Conti VR. Integrating resuspension with remodeling: Early results with a new valve-sparing aortic root reconstruction technique. Journal of Heart Valve Disease. 2008 Jan 1;17(1):74-80.
Kollar, Andras C. ; Lick, Scott D. ; Conti, Vincent R. / Integrating resuspension with remodeling : Early results with a new valve-sparing aortic root reconstruction technique. In: Journal of Heart Valve Disease. 2008 ; Vol. 17, No. 1. pp. 74-80.
@article{7338e3d5a28e4f8c8852aa1e8e637f18,
title = "Integrating resuspension with remodeling: Early results with a new valve-sparing aortic root reconstruction technique",
abstract = "Background and aim of the study: Currently, two different valve-sparing aortic root reconstruction methods are utilized, namely reimplantation and remodeling. Herein are reported the authors' early results with a new technique that integrates the two procedures. Methods: Seven patients (age range: 25-69 years) underwent valve-sparing aortic root replacement with a new technique that integrates the principles of the David and Yacoub operations. The preoperative aortic root sizes were 4.9 to 7.0 cm, and six patients had aortic regurgitation (grade 1+ to 3+). Surgery was divisible into four stages: (i) External subcommissural (downsizing) annuloplasty; (ii) graft sizing and valve competency assessment with saline squirt test; (iii) sewing the individual tongues of a hand-scalloped Hemashield graft to the annular tissue with subvalvular pledgeted mattress sutures; and (iv) running suture lines to the commissural aspects of the aortic wall, followed by coronary reimplantation. Results: All patients survived surgery. Intraoperative transesophageal echocardiography showed trace aortic incompetence (AR) in five patients, and mild or moderate AR each in one patient. Over a two-year period the technique was improved to the above-described, four-stage approach, which resulted in only trace AR in the final three patients. Early serial transthoracic echocardiography confirmed stable root dimensions and no progression of AR, except in an early patient. Conclusion: In the described technique, graft sizing is strictly tied to early intraoperative valve competency testing after an initial reconstruction within the native aortic root. The operation is then converted into a modified remodeling by suturing the triple-tongued (Yacoub) graft to the true aortic annulus with subannular pledgets (David principle). The operation involves significantly less dissection around the aortic root, and the entire scalloped annulus is stabilized in between the graft material and pledgets.",
author = "Kollar, {Andras C.} and Lick, {Scott D.} and Conti, {Vincent R.}",
journal = "Journal of Heart Valve Disease",
publisher = "ICR Publishers Ltd",
T1 - Integrating resuspension with remodeling
T2 - Early results with a new valve-sparing aortic root reconstruction technique
AU - Kollar, Andras C.
AU - Lick, Scott D.
AU - Conti, Vincent R.
N2 - Background and aim of the study: Currently, two different valve-sparing aortic root reconstruction methods are utilized, namely reimplantation and remodeling. Herein are reported the authors' early results with a new technique that integrates the two procedures. Methods: Seven patients (age range: 25-69 years) underwent valve-sparing aortic root replacement with a new technique that integrates the principles of the David and Yacoub operations. The preoperative aortic root sizes were 4.9 to 7.0 cm, and six patients had aortic regurgitation (grade 1+ to 3+). Surgery was divisible into four stages: (i) External subcommissural (downsizing) annuloplasty; (ii) graft sizing and valve competency assessment with saline squirt test; (iii) sewing the individual tongues of a hand-scalloped Hemashield graft to the annular tissue with subvalvular pledgeted mattress sutures; and (iv) running suture lines to the commissural aspects of the aortic wall, followed by coronary reimplantation. Results: All patients survived surgery. Intraoperative transesophageal echocardiography showed trace aortic incompetence (AR) in five patients, and mild or moderate AR each in one patient. Over a two-year period the technique was improved to the above-described, four-stage approach, which resulted in only trace AR in the final three patients. Early serial transthoracic echocardiography confirmed stable root dimensions and no progression of AR, except in an early patient. Conclusion: In the described technique, graft sizing is strictly tied to early intraoperative valve competency testing after an initial reconstruction within the native aortic root. The operation is then converted into a modified remodeling by suturing the triple-tongued (Yacoub) graft to the true aortic annulus with subannular pledgets (David principle). The operation involves significantly less dissection around the aortic root, and the entire scalloped annulus is stabilized in between the graft material and pledgets.
AB - Background and aim of the study: Currently, two different valve-sparing aortic root reconstruction methods are utilized, namely reimplantation and remodeling. Herein are reported the authors' early results with a new technique that integrates the two procedures. Methods: Seven patients (age range: 25-69 years) underwent valve-sparing aortic root replacement with a new technique that integrates the principles of the David and Yacoub operations. The preoperative aortic root sizes were 4.9 to 7.0 cm, and six patients had aortic regurgitation (grade 1+ to 3+). Surgery was divisible into four stages: (i) External subcommissural (downsizing) annuloplasty; (ii) graft sizing and valve competency assessment with saline squirt test; (iii) sewing the individual tongues of a hand-scalloped Hemashield graft to the annular tissue with subvalvular pledgeted mattress sutures; and (iv) running suture lines to the commissural aspects of the aortic wall, followed by coronary reimplantation. Results: All patients survived surgery. Intraoperative transesophageal echocardiography showed trace aortic incompetence (AR) in five patients, and mild or moderate AR each in one patient. Over a two-year period the technique was improved to the above-described, four-stage approach, which resulted in only trace AR in the final three patients. Early serial transthoracic echocardiography confirmed stable root dimensions and no progression of AR, except in an early patient. Conclusion: In the described technique, graft sizing is strictly tied to early intraoperative valve competency testing after an initial reconstruction within the native aortic root. The operation is then converted into a modified remodeling by suturing the triple-tongued (Yacoub) graft to the true aortic annulus with subannular pledgets (David principle). The operation involves significantly less dissection around the aortic root, and the entire scalloped annulus is stabilized in between the graft material and pledgets.
JO - Journal of Heart Valve Disease
JF - Journal of Heart Valve Disease