Midterm follow-up of the reimplantation technique in patients with relatively normal annulus: Is David I still a clinically valid option?

n/

Midterm follow-up of the reimplantation technique in patients with relatively normal annulus: is David I still a clinically valid option?

OBJECTIVE: The aim of this study was to evaluate the midterm results of the reimplantation technique with a straight tubular graft in patients with aortic root aneurysms with or without aortic insufficiency. METHODS: From February 2002 to November 2012, 51 consecutive patients underwent the David I valve-sparing aortic procedure for aortic root aneurysm; the mean age was 59.9±12.3 years. Nine patients (17.6%) had a bicuspid aortic valve. Patients were followed prospectively for 4.78±3.60 years (median, 5 years). Operative results, survival, freedom from redo aortic surgery and from recurrent aortic insufficiency greater than 2+ were assessed. RESULTS: No in-hospital mortality was recorded. In 5 cases, adjunctive procedures on the aortic valve were needed to achieve good leaflet coaptation. Aortic regurgitation was significantly lower at discharge (2.3±1.0 vs 0.3±0.5; P<.001). There were 5 postoperative deaths, all noncardiac related. Survival was 91.0%±4.4% at 5 years; freedom from redo aortic surgery was 96.8%±3.2% and freedom from recurrent aortic insufficiency greater than 2+ was 96.8%±3.2%. The outcomes in patients with repaired bicuspid aortic valves showed no significant differences compared to the outcomes in patients with repaired tricuspid valves. CONCLUSIONS: The reimplantation procedure using a straight tube is a safe and reproducible valve-sparing technique that can achieve no in-hospital mortality and durable midterm results, either in bicuspid or tricuspid valves. Further studies are needed to assess the behavior of repaired valves under physical stress at long-term follow-up

Necklace State Hallmark in Disordered 2D Photonic Systems

Necklace states arise from the coupling of otherwise confined modes in disordered photonic systems and open high transmission channels in strongly scattering media. Despite their potential relevance in the transport properties of photonic systems, necklace state statistical occurrence in dimensions higher than one is hard to measure, because of the lack of a decisive signature. In this work we provide an efficient method to tell apart in a single measurement a coupled mode from a single localized state in a complex scattering problem, exploiting the analogy with well-characterized coupled cavities in photonic crystals. The phase spatial distribution of the electromagnetic field has been numerically calculated and analyzed as a function of the coupling strength and of detuning between interacting modes respectively for coupled photonic crystal cavities and for partially disordered systems. Results consistently show that when localized modes spectrally and spatially overlap only over a small surface extent, synchronous oscillation does not build up and the phase spatial distribution splits into two distinct peaks. Having established such bimodal distribution as a necklace hallmark, this paper opens the possibility to assess and eventually tailor the role of necklace states in random systems, e.g., by varying correlations