Concomitant aortic valve and ascending aorta replacement with moderate hypothermic circulatory arrest to treat an aortic bicuspid valve with post-stenotic dilatation.
ABSTRACT We recommend concomitant surgery for aortic valve replacement (AVR) and ascending aortic replacement using moderate hypothermic circulatory arrest (CA) for post-stenotic dilatation complicated by an aortic bicuspid valve. Cardiopulmonary bypass (CPB) was established from the right atrium to the dilated ascending aorta. As soon as the rectal temperature decreased to 28 °C, CA was commenced and the open distal anastomosis of a polyester prosthesis, without any cerebral perfusion, was completed. AVR was then carried out during rapid re-warming with CPB using a side arm of the prosthesis. This procedure exhibited safe and satisfactory results. There are many benefits of carrying out the procedure in this way; it avoids the requirement for cannulation to a calcified aortic arch, provides a good operative field, for an easier distal anastomosis and suturing at the valve site, and reduces the risk of further dilatation or dissection of the residual ascending aorta in the later phase.
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ABSTRACT: A technique for complete replacement of the aortic valve and ascending aorta in cases of aneurysm of the ascending aorta with aortic valve ectasia is described. The proximal aortic root was too attenuated to afford anchorage to the aortic prosthesis, so this was sutured to the ring of a Starr valve and the prostheses were inserted en bloc. The ostia of the coronary arteries were anastomosed to the side of the aortic prosthesis.Thorax 08/1968; 23(4):338-9. · 8.38 Impact Factor
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ABSTRACT: To evaluate the effectiveness of tailoring aortoplasty used to treat fusiform aneurysms of the ascending aorta, we reviewed the results of operation in 17 patients. Nine patients had tailoring aortoplasty alone, and 8 patients had aortoplasty with Dacron wrap of the ascending aorta. Fourteen of 17 patients were discharged from the hospital, and 12 patients were alive at follow-up between 2 and 120 months. Of two late deaths, neither was due to aneurysmal disease. Actuarial survival at 1 and 10 years was 81% and 63%, respectively. In selected cases, tailoring aortoplasty can achieve long-term results comparable with those of resection and graft replacement of fusiform ascending aortic aneurysms.The Annals of Thoracic Surgery 03/1995; 59(2):497-51. · 3.45 Impact Factor
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ABSTRACT: Five to fifteen percent of patients undergoing aortic valve replacement (AVR) will have an ascending aortic aneurysm requiring a concomitant surgical procedure. On the other hand, a dilated ascending aorta is known to be a potential source of complications after AVR. From 1972 to 1988, 2278 AVR, either isolated or combined with a second cardiac procedure, were performed in our institution. In the same time interval, a dilated ascending aorta was treated in additional 291 consecutive patients during AVR. Three different surgical options were employed: aortic remodelling and external wall support in 164 patients (56.4%), composite graft replacement in 81 patients (27.8%) and a supracoronary graft in 46 patients (15.8%). Early mortality was 4.8%. Aortic remodelling plus external wall support had the lowest early mortality (1.8%) and the best 8-year survival (89.6%). Supracoronary grafting had a higher early mortality (6.4%) and lower 8-year survival (73.2%). The results of the composite graft were least favourable: early mortality was 9.8% and 8-year survival 76.5%. The results point out the necessity for instituting the appropriate surgical procedure for a dilated ascending aorta during AVR. They show that conservative aortic surgery with preservation of endothelial lining gives excellent early and late results.European Journal of Cardio-Thoracic Surgery 02/1991; 5(3):137-43. · 2.67 Impact Factor