Valve-sparing aortic root replacement using the reimplantation (David) technique:a systematic review and meta-analysis on survival and clinical outcome

BACKGROUND: Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype. METHODS: We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery. RESULTS: Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs. CONCLUSIONS: This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs

The Benefits of Lateral Thoracotomy Left Ventricular Assist Device Implantation.

TO THE EDITOR : Since the introduction of less-invasive left ventricular assist device (LVAD) implantation techniques through a left thoracotomy (LT), the notion has been perpetuated that right ventricular (RV) function overall is improved. This knowledge was simply passed on from one surgeon to the next and was quickly adopted as common knowledge. This notion, however, was merely based on anecdotes and personal observations shared by some of the pioneers of this approach. [...

Diagnostische Wertigkeit von QT-Prolongation und QT-Dispersion als Zeichen für akute kardiale Abstoßungsreaktionen nach orthotoper Herztransplantation

$\bf Problem:$ Das frühe Erkennen von Abstoßungsepisoden ist essentiell für die postoperative Betreuung und das Überleben herztransplantierter Patienten. $\bf Methoden:$ 200 Patienten wurden hinsichtlich akuter Abstoßungsepisoden in den ersten 90 Tagen nach HTx retrospektiv evaluiert. Diese Studie diente der Begutachtung von QT-Zeit-Alterationen. $\bf Ergebnis:$ Bei akuten Abstoßungsepisoden ($\geq$ ISHLT II) kam es zu einer signifikanten (p<0,001) Verlängerung der frequenzkorrigierten QT-Zeit ($\Delta$QTc) um mehr als 10%. Die Sensitivität der QTc-Zeit, akute kardiale Rejektionen aufzuzeigen, beträgt 77% und Spezifität 96%. Zusätzlich kam es zu einer signifikanten (p<0,001) Erhöhung der QTc-Dispersion ($\Delta$QTc-Dispersion) um mehr als 100%. Die Sensitivität, akute kardiale Rejektionen aufzuzeigen, ist hierbei 70% und die Spezifität 95%. $\bf Diskussion:$ Akute kardiale Abstoßungsreaktionen führen zu Veränderungen in den kardialen Erregungsleitungseigenschaften, die anhand von QT-Zeit-Alterationen erkannt werden können

Bicuspid aortic valve repair: the 180°-Reimplantation technique.

Bicuspid aortic valves (BAVs) represent a wide spectrum of aortic valve phenotypes. We have therefore previously proposed a new repair-oriented surgical classification for BAVs in order to facilitate our understanding of any given phenotype and to guide surgical repair. BAVs can range from symmetric to very asymmetric, and classification is determined by commissural orientation. This can therefore range from 180° to 120° respectively, and as such has further implications for the presence or absence of a raphe; the height of the non-functional commissure (raphe); the length of the line of cusp fusion; and the architecture of the aortic valve sinuses. Over the last three decades, we have attempted different repair strategies for BAVs, with its respective learning curves and have achieved the best long-term repair results with our signature approach: the 180°-Reimplantation technique (El Khoury technique). Although very asymmetric and tricuspid aortic valve-like phenotypes are sometimes best repaired through tricuspidization, we have found that the majority of BAVs are amenable to our 180°-Reimplantation technique. This technique creates a symmetric valve, through a selective annuloplasty, and stabilization of the entire functional aortic annulus (FAA) with reimplantation of the commissure at 180° at the level of the virtual basal ring (VBR) and sinotubular junction (STJ). Depending on the valve phenotype, additional cusp modifications are often required to address one or two prolapsing cusps and/or a fibrous raphe. With this, we have previously reported a 12-year survival rate of 94%, which is alike the general population, and also an overall freedom from aortic valve reoperation of 91%

The Ross Procedure: A Rekindled Relationship.

Over the last few years, there has been renewed interest in aortic valve replacement with a living pulmonary autograft. The reason is simple: studies have shown that long-term survival after the Ross procedure mirrors that of the general population,1 results that have not yet been achieved with prosthetic aortic valves. [...

Forme Fruste or Commissural Avulsion?

To the Editor: Aortic valves (AVs) encompass a broad spectrum of valve phenotypes that can sometimes even mimic each other.1 Nonetheless, this is generally inconsequential as we usually excise AVs and simply replace them. [...

Is extension of Florida Sleeve indications taking us in the right direction?

Aortic valve (AV) and aortic root pathologies can be approached in different ways. These range from replacement therapies to valve-preserving techniques (reimplantation or remodelling technique). Although most surgeons are comfortable with composite graft replacements (modified Bentall procedure), valve-sparing procedures remain somewhat challenging. Effectively, valvesparing approaches require a more in-depth understanding of the aortic root anatomy and valve function. [...

Reimplantation should be the gold standard to treat the regurgitant bicuspid aortic valve

no abstract availabl

Commissural geometry and cusp fusion insights to guide bicuspid aortic valve repair.

No abstract availabl

En bloc aortic root resection and Commando procedure for aortomitral bioprosthetic endocarditis

Early aortomitral bioprosthetic degeneration with acute endocarditis represents a surgical challenge because it requires thoughtful preoperative evaluation and anticipation of a complex and difficult reoperation. The aortomitral continuity and fibrous skeleton is often completely destroyed, and hence mandates a double valve replacement with recreation of a new aortomitral continuity, with a pericardial patch for instance. This technique was originally described by Tirone David, and was named Commando procedure by the Cleveland Clinic group.1 Approaching the aortic root in the setting of redo surgeries is a challenge in and of itself, and herein we describe our technique for en bloc aortic root resection, followed by a Commando procedure