• Journal of Chest Surgery
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• v.45 no.4
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• pp.205-212
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• 2012

Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.

• Journal of Chest Surgery
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• v.49 no.4
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• pp.264-272
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• 2016

Background: We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. Methods: We reviewed 142 cases of acute DeBakey type I aortic dissections (1996-2015). Seventy percent of the cases were ascending aortic replacements, and 3 0% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches. Fourteen percent (20 cases) resulted in surgical mortality and 86% of cases that survived had a mean follow-up period of $6.6{\pm}4.6years$. Among these cases, 64% of the patients were followed up with computed tomography (CT) angiograms with the duration of the final CT check period of $4.9{\pm}2.9years$. Results: There were 15 cases of reoperation in 13 patients. Of these 15 cases, 13 cases were in the ascending aortic replacement group and 2 cases were in the total arch aortic replacement group. Late mortality occurred in 13 cases; 10 cases were in the ascending aortic replacement group and 3 cases were in the total arch aortic replacement group. Eight patients died of a distal aortic problem in the ascending aortic replacement group, and 1 patient died of distal aortic rupture in the total arch aortic replacement group. The follow-up CT angiogram showed that 69.8% of the ascending aortic replacement group and 35.7% of the total arch aortic replacement group developed distal aortic dilatation (p=0.0022). Conclusion: The total arch aortic replacement procedure developed fewer distal remnant aortic problems from dilatation than the ascending aortic replacement procedure in acute type I aortic dissections.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.266-270
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• 1993

Aortic valve insufficiency with ventricular septal defect is usually treatment by plication of prolased cusps. We have performed the aortic valvuloplasty by the Trusler`s method in 14 patients of ventricular septal defect associated with aortic insufficiency. The reoperations were performed in the 4 cases[29%] due to recurrent aortic insufficiency after aotic valvuloplasty. Two patients underwent aoritc valvular replacements for the tears of repaired aortic cusps after primary aortic valvuloplasty for aortic insufficiency. The other two patients had aortic valvuloplasties again. Death occured in one case of aortic valvular replacements. The cause of death was low cardiac output syndrome soon after aortic valvular replacement for recurrent aortic insufficiency .

• Journal of Chest Surgery
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• v.18 no.4
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• pp.663-666
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• 1985

Whatever a surgeon choose aortic prosthesis in aortic stenosis, it will always provoke some degree of obstruction to flow due to its smaller effective orifice area to tissue annulus. Occasionally, we meet small aortic annulus to his or her body surface area in aortic valve replacement. The small annulus remains a problem in that both tissue and mechanical prosthesis have significant pressure gradients between LV and aorta in resting or exercising states. In these circumstances, diverse surgical procedures, such as tilting disc prosthesis, supraannular position of aortic prosthesis, and enlargement of aortic root [including aortoventriculoplasty, translocation of aortic valve, & double outlet of LV by valved conduit], were applied. We experienced one case of aortic stenosis with small aortic annulus. Systolic pressure gradients between LV & aorta were 90 mmHg. Diameter of annulus was 19 mm. So we performed patch enlargement of aortic root by Manouguian and AVR with St. Jude medical valve 23 mm.

• Journal of Chest Surgery
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• v.45 no.6
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• pp.404-407
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• 2012

Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.748-751
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• 2000

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root(Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.

• Journal of Chest Surgery
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• v.52 no.5
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• pp.368-371
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• 2019

A unicuspid aortic valve is a rare congenital malformation that frequently presents with valvular dysfunction and dilatation or aortic aneurysm, requiring combined aortic valve surgery and aortic repair. Some patients show severe valve calcification extending into the interventricular septum, possibly resulting in damage to the conduction system during debridement for valve replacement. We present a rare case of severe aortic stenosis with a unicommissural unicuspid aortic valve diagnosed by preoperative transesophageal echocardiography in a 36-year-old man. After composite graft replacement of the aortic valve, aortic root, and ascending aorta, a permanent pacemaker was placed because of postoperative complete heart block.

• Journal of Biomedical Engineering Research
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• v.29 no.2
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• pp.151-158
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• 2008

To evaluate aortic wall stiffness without influence of different background blood pressure, a new technique was developed and verified. At eight swine descending aortae, volume-pressure measurement was performed using custom-made system. Based on averaged pressure-volume curve, aortic distensibility index was formulated to evaluate aortic wall stiffness regardless of variable blood pressure and aortic size. The variability of aortic distensibility index by pressure change was compared with other parameters for wall stiffness evaluation. Subsequently, the aortic distensibility index was calculated at 100 contrast-enhanced EBCT data sets of normal volunteers in regular health screening program. The measured aortic distensibility index was compared with age, coronary calcium score, and aortic calcium score. Between 50 and 360 mmHg of blood pressure, the coefficient of variance of aortic distensibility index was 22.00% as comparing with 88.99% of classical compliance. Based on age, aortic distensibility index showed correlation coefficient of 0.55, whereas classical compliance showed 0.26. The correlation coefficient with modified aortic calcification was 0.43. Linear regression study revealed statistical significance of correlation coefficients. The aortic distensibility index, the method to evaluate aortic wall stiffness free from variable blood pressure and aortic size, was developed and verified with significant practical feasibility.

• Journal of Chest Surgery
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• v.56 no.4
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• pp.255-261
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• 2023

Background: The surgical threshold for bicuspid aortic valve (BAV)-related aortopathy is a matter of debate due to its uncertain etiology and prognosis. This study investigated the prognosis of unrepaired BAV aortopathy in patients undergoing surgical aortic valve replacement (SAVR). Methods: We retrospectively analyzed data from 720 patients (age, 60.8±11.5 years; 246 women) who underwent SAVR for BAV disease without aortic repair between 2005 and 2020 at Asan Medical Center. The clinical endpoints were defined as occurrences of sudden death, aortic dissection or rupture, and elective aortic repair. To estimate postoperative changes in the dimensions of the unrepaired aorta, the individual annual aortic expansion rate was calculated. Multiple linear regression models were used to evaluate the risk of aortic expansion. Results: The mean ascending aortic diameter was 39.5±4.6 mm, and 299 patients (41.5%) had a baseline ascending aorta diameter >40 mm. During 70.0±68.3 months of follow-up, the mean annual aortic expansion rate was 0.39±1.96 mm/yr, no aortic dissection or rupture was observed, and sudden deaths were reported in 12 patients (0.34% per person-year). Linear regression analysis revealed no significant correlation between the baseline ascending aortic diameter and postoperative aortic expansion (R²=0.004, β=-0.84, p=0.082). Conclusion: In selected patients undergoing SAVR for a BAV (<55 mm), the risk of adverse aortic events was very low. As this observation contradicts current practice guidelines advocating for proactive aortic replacement in dilated ascending aortas measuring >45 mm, the study results need further validation by studies involving larger populations or randomized controlled trials.

• Journal of Chest Surgery
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• v.45 no.3
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• pp.141-147
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• 2012

Background: Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods: A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results: The mean follow-up duration was $4.9{\pm}3.1$ years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of $4.4{\pm}2.5$ years of echocardiographic follow-up (p<0.001). Conclusion: Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures.