Objective To observe the intermediate-term outcome and heart function in patients with small aortic root，and to investigate the feasi bility of small size prosthesis. Methods From July 1990 to Jun e 2003, 62 patients underwent 19mm aortic valve prosthesis(19mm group). The resu lts were compaired with other 62 patients receiving larger prosthesis(≥21 mm,21 mm group). Clinical symptoms, signs, electrocardiogram(ECG) and echocardiogr a phy (UCG) were followedup, KaplanMeier survival curve was used for analysis. Results In 19mm group, there were 38 patients with ≥Ⅱ/Ⅵ grade systolic murmur in aortic valve area,18 patients with ECG ST segm ent change and 11 patients with chest pain and/or chest distress. Postoperative cardiac function showed that 33 patients with heart function New York Heart Ass ociation(NYHA) class Ⅱ and 29 patients with NYHA class Ⅲ. Postoperative ECG sh owed in 21mm group,6 patients with ECG ST segment change,3 patients with chest distress and 6 patients with occasional chest pain and there were 48 patients with NYHA class Ⅱ and 14 patients with NYHA class Ⅲ,there was statis tically difference in heart function between two groups（P＝0.020). Th ere was a significant regression of left ventricular end diastolic diameter(LVEDD),left ventricular wall thickness, mass index,and pressure gradients in both groups（P＜0.05）, and left ventricular ejection f raction (LVEF)had a significant increase in patients 5 years after operation tha n that before operation（P＜0.05）, and there was no statistically differenc e in both groups（P＞0.05）. Actual survival at 1,5 years were 93.5%,74 .2% in 19mm group compared with 95.2%,790% in the 21mm valve group, there were no statistically difference in both groups （P=0.231,0.110）. Conc lus ion Patients with 19mm prosthetic aortic valves can experience a satisf actory improvement and get excellent intermediate-term survival.
ObjectiveTo explore growth pattern of neo-aortic root as well as development of neo-aortic regurgitation after arterial switch operation (ASO) for Taussig-Bing anomaly. MethodsFrom 2002 to 2017, the patients who received ASO, and were discharged alive from Shanghai Children’s Medical Center and followed up for more than 3 years were retrospectively involved in this study. ResultsA total of 127 patients were enrolled. There were 98 (77.2%) males, the median age at ASO was 73.0 d and the average weight was 4.7 kg. Forty-five (35.4%) children were complicated with mild or mild-to-moderate pulmonary insufficiency (PI) before ASO. The average follow-up time was 7.0 years. During the follow-up, 14 (11.0%) children presented moderate or greater neo-aortic regurgitation (neo-AR). The diameter of neo-aortic annulus and sinus of Valsalva was beyond normal range during the entire follow-up. The average diameter of neo-aortic annulus was 18.0 mm at 5 years and 20.5 mm at 10 years. The average diameter of sinus of Valsalva was 25.9 mm at 5 years and 31.1 mm at 10 years. Neo-AR continued to develop over time. The diameter of children who developed moderate or greater neo-AR was constantly larger than that of children who did not (χ2=18.3, P<0.001). Preoperative mild or mild-to-moderate PI was an independent risk factor for the development of moderate or greater neo-AR during mid-to-long term follow-up (c-HR=3.46, P=0.03). ConclusionThe diameters of neo-aortic annulus and sinus of Valsalva of Taussig-Bing children who receive ASO repair continue to expand without normalization. The dilation of annulus correlates with the development of neo-AR. PI before ASO repair increases the risk of neo-AR development.
ObjectiveTo explore the effect of the reimplantation procedure with the De Paulis Valsalva graft in patients with aneurysms. MethodsWe retrospectively analyzed the clinical data of 38 patients underwent valve-sparing aortic root replacement using De Paulis graft in our hospital between September 2005 and July 2013.There were 32 male and 6 female patients at age of 45.5±12.4 years. We compared the parameters of pre-operation and post-operation and followed up the patients for 5 years. ResultsThere were 2(5.3%) deaths in hospital. The follow-up time was 2-95 months with following-up rate of 92.1%(35/38). A total of 2 patients(5.3%) had grade 3 to grade 4 aortic insufficiency. And one of these patients received aortic valve replacement after 1 year. At 5 years of following-up, one patient died of septic shock due to pacemaker infection. One patient died of kidney failure due to renal artery dissection aneurysm affected with impaired renal function and long-term hemodialysis. ConclusionThe reimplantation type of valve-sparing procedure can be facilitated by the use of the De Paulis valsalva graft and can be performed with satisfactory perioperative and mid-term results.
ObjectiveTo evaluate the feasibility and safety of modified Yacoub technique with aortic annuloplasty in the patients with aortic root aneurysm and dilatation of aortic annular base.MethodsWe performed a retrospective review of 6 patients with aortic root aneurysm undergoing modified Yacoub technique with aortic annuloplasty from November 2017 to January 2019. There were 5 males and 1 female, with a mean age of 54.1±12.3 years. The preoperative cardiac function of 3 patients was in New York Heart Association (NYHA) classⅡand the other 3 patients were in class Ⅲ. There were two patients with bicuspid aortic valve, and no Marfan syndrome. There was aortic regurgitation in the patients measured by the echocardiogram, 1 in mild aortic regurgitation, 1 in moderate aortic regurgitation, and 4 in severe aortic regurgitation. The diameter of aortic annular base was 27.8±1.9 mm, and the largest diameter of aortic root was 49.8±3.7 mm. Six patients underwent modified Yacoub technique with aortic annuloplasty, including 5 patients who underwent aortic cusp repair at the same time.ResultsAll 6 identified patients survived. There was no severe complication (bleeding, stroke, or acute renal failure). The cardiopulmonary bypass time was 204.6±13.5 min, aortic cross-clamping time 168.0±17.1 min, mechanical ventilation time 21.3±19.5 h, ICU stay time 67.8±62.2 h. The follow-up time ranged from 4 to 18 months with an average time of 12.8±4.7 months. Patients' cardiac function improved postoperatively with four patients in NYHA classⅠand two patients with classⅡ. Two patients had no aortic valve regurgitation, four patients had mild regurgitation. Left ventricular end diastolic volume decreased significantly (118.6±20.4 mL vs. 169.1±58.4 mL, P<0.05).ConclusionThe modified Yacoub technique with aortic annuloplasty is effective and safe for the patients with aortic root aneurysm and dilatation of aortic annular base, and the early- and mid-term outcomes are satisfactory.
This study aims to explore the effect of aortic sinus diameter on aortic valve opening and closing performance in the case of no obvious disease of aortic valve and annulus and continuous dilation of aortic root. A total of 25 three-dimensional aortic root models with different aortic sinus and root diameters were constructed according to the size of clinical surgical guidance. The valve sinus diameter DS is set to 32, 36, 40, 44 and 48 mm, respectively, and the aortic root diameter DA is set to 26, 27, 28, 29 and 30 mm, respectively. Through the structural mechanics calculation with the finite element software, the maximum stress, valve orifice area, contact force and other parameters of the model are analyzed to evaluate the valve opening and closing performance under the dilated state. The study found that aortic valve stenosis occurs when the DS = 32 mm, DA = 26, 27 mm and DS = 36 mm, DA = 26 mm. Aortic regurgitation occurs when the DS = 32, 36 and 40 mm, DA = 30 mm and DS = 44, 48 mm, DA = 29, 30 mm. The other 15 models had normal valve movement. The results showed that the size of the aortic sinus affected the opening and closing performance of the aortic valve. The smaller sinus diameter adapted with the larger root diameter and the larger sinus diameter adapted with the smaller root diameter. When the sinus diameter is 40 mm, the mechanical performance of the valve are good and it can well adapt with the relatively large range of aortic root dilation.
Valve transplantation is often used in the treatment of aortic valve insufficiency. However, after surgery, the reconstructed aortic roots have an expansion phenomenon, in which the lack of valve height causes the aortic valve to close again. In this paper, the effects of different aortic valve height design on valve opening and closing performance were studied. The optimal surgical plan was obtained by in vitro numerical simulation, providing technical support and theoretical basis. In this paper, six groups of three-dimensional geometric models with a valve height increment of ± 0.5 mm were established with a root diameter of 26.0 mm and a valve height of 14.0 mm. Through the structural mechanics calculation and analysis of the parameters such as maximum stress, valve area and contact force of the model, reasonable geometrical dimensions are obtained. The study found that the maximum stress values of the six groups of models ranged from 640 to 690 kPa, which was consistent with the results of the literature; the three-group models with valve heights of 13.5 mm, 14.0 mm, and 14.5 mm were within a reasonable range. The contact force value of the 6 groups of leaflets increased with the increase of valve height. Studies have shown that the height of the aortic valve has an effect on the aortic valve closure performance. A valve height that is too small or too large will reduce the aortic systolic valve area and affect the aortic function.
ObjectiveTo evaluate the data of preoperative aortic root CT angiography (CTA), compare it with two-dimensional transthoracic echocardiography and investigate the correlation of the two measurements with the actual intraoperative measurement data.MethodsClinical data of 53 patients with aortic valve diseases who underwent aortic valve repair in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 38 males and 15 females with an average age of 42.9±18.3 years ranging from 10 to 77 years. Preoperative two-dimensional transthoracic echocardiography (TTE) and aortic root CTA measurements were collected, including aortic valve annulus (AVA), aortic sinus (Sinus) and sino-tubular junction (STJ). In comparison with the intraoperative measurements during the aortic valve repair surgery, the consistency analysis was performed.ResultsBoth the preoperative echocardiography AVA measurements and the CT AVA measurements were positively correlated with the intraoperative AVA measurements (P<0.001). Compared with the echocardiography AVA data [correlation coefficient (ρ)=0.74, mean squarederror (MSE)=12.78], the CT AVA data were more accurate and consistent with the intraoperative AVA measurements (ρ=0.95, MSE=2.72). CT AVA data had a higher correlation coefficient with the intraoperative measurements, compared to that of the echocardiography AVA data (P<0.001).ConclusionIn comparison with two-dimensional transthoracic echocardiography, preoperative morphological evaluation of aortic root CTA is more consistent with the actual intraoperative measurements during aortic valve repair surgery.
Objective To investigate and evaluate the safety and efficacy of the aortic-mitral annular enlargement technique (double annular enlargement) in patients with small-size valve prostheses after prior valve surgery. MethodsThe clinical data of patients who underwent double valve annular enlargement in Wuhan Asia Heart Hospital from April 2020 to April 2022 were retrospectively analyzed. Results A total of 30 patients were collected, including 2 males and 28 females aged 9-78 (52.71±3.53) years. All patients had previous heart valve surgery, including 1 patient receiving the third heart surgery. All patients were operated on successfully and there were no postoperative in-hospital deaths. There was no postoperative bleeding which needed a secondary open-chest hemostasis, and one patient underwent permanent pacemaker implantation due to postoperative sick sinus syndrome. The mean diameter of the implanted prosthetic aortic valve was 24.23±1.60 mm, which was significantly larger than that of the preoperative aortic valve (21.03±1.90 mm, P＜0.001). The mean diameter of the implanted prosthetic mitral valve was 28.33±1.21 mm, which was significantly larger than that of the preoperative mitral valve (25.43±0.84 mm, P＜0.001). The mean peak gradient difference across the prosthetic aortic valve on postoperative echocardiography was 18.17±6.44 mm Hg, which was significantly lower than that of the preoperative aortic valve (82.57±24.48 mm Hg, P＜0.001). The mean peak gradient difference of the postoperative prosthetic mitral valve was 12.73±5.45 mm Hg, which was significantly lower than that of the preoperative mitral valve (19.43±8.97 mm Hg, P=0.003). Conclusion The double annular enlargement technique is safe and effective for reoperation in patients with a history of valve surgery with a small aortic root to obtain both a larger size prosthetic valve for a larger orifice area and stability of the mitral-aortic valve union, resulting in good postoperative hemodynamic characteristics and clinical outcomes.
Objective To compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute type A aortic dissection, including aortic valve (AV) resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement procedure (Bentall). Methods All patients who underwent acute Type A aortic dissection repair between January 2010 and December 2015 in Fuwai Hospital were retrospectively analyzed in our study. There were 673 patients with 512 males and 161 females at mean age of 48.80±11.22 years. There were 403 patients as an AV resuspension group (287 males and 116 females at average age of 50.61±9.95 years), 95 patients as an isolated supracoronary ascending aorta replacement group (76 males and 19 females at average of 49.83±12.21 years), and 175 patients as an AV resuspension group (149 males and 26 females at average of 44.07±11.99 years). The differences of preoperative aortic insufficiency, intraoperative variables and postoperative aortic insufficiency were compared in the three groups. Results Five hundred ninety-one patients (87.8%) had aortic valve commissure involved. The proportion of mild degree, moderate degree, and severe degree among the three groups were statistically significant (31.7%, 52.4%, 15.9%; 87.4%, 12.6%, 0.0%; 23.4%, 56.0%, 20.6%; P < 0.01). The diameter of aortic sinus in the three groups was 39.06±5.11 mm, 38.27±4.41 mm, 50.39±6.22 mm, respectively, with a statistical difference ( P< 0.01). The duration of surgery, cardiopulmonary bypass time, aorta cross-clamp time were also statistically significant (P < 0.01). The in-hospital mortality was 11.73% in the whole group. There was no difference among the three groups (12.2% vs. 13.7% vs. 9.7%, P=0.58). Five-year survival rate was similar (83.06% vs. 81.27% vs. 83.05%, P=0.85). The 5-year free from over moderate aortic insufficiency rate were 95.2%, 98.6% and 100% respectively, with no statistical difference (P=0.07). There was no re-do operation for aortic root diseases in the whole group. Conclusion According to aortic root processing strategy in our center, AV resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement can achieve satisfactory results. However, there is higher incidence of aortic insufficiency through AV resuspension. Further study is needed to evaluate its efficacy.
Objective To analyze clinical outcome of the technique of comprehensive aortic root and valve reconstruction (CARVAR) applying in aortic valve and root disease. Methods We retrospectively analyzed the clinical data of 106 patients with aortic valve and root disease underwent CARVAR technique in our hospital from July 2012 to July 2015. There were 72 males and 34 females at the average age of 57.3 (11-67) years. We operated the CARVAR technique and analyzed the early and midterm clinical outcomes. Results There was no mortality and low cardiac output syndrome postoperatively. But there were 2 cases of renal insufficiency or failure and 1 case of infective endocarditis. The average ejection fraction was 54%. The mean area of aortic valve orifice was 2.2±0.8 cm2. The aortic valve pressure gradient was 11.2±2.3 mm Hg. There were 2 cases of mild aortic valve regurgitation. The result of operation was satisfying with a stable hemodynamics and few complications. The follow-up after surgery showed that there was no obvious abnormity in aortic valve and root. Conclusion Using CARVAR technique to cure aortic valve and root disease is an effective treatment and it can achieve satisfactory early and midterm clinical outcomes.