The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.
ObjectiveTo explore the early results of Ozaki operation in children with aortic regurgitation.MethodsWe retrospectively analyzed the clinical data of 15 patients with aortic regurgitation who received the Ozaki operation in our hospital from April 2017 to July 2019. There were 11 males and 4 females with an average operation age of 10.7±3.7 years. Besides preoperative evaluation, aortic regurgitation and cardiac function were evaluated on 1 day, 1 week, 1 month, 3 months, and 6-12 months after surgery.ResultsIn 14 (93.3%) patients , the aortic valve leaflets functioned well on 1 day, 1 month, 3 months, and 6-12 months, and the regurgitation grade was Ⅰ-Ⅱ, which was improved than before (P=0.001). The cardiac function of children recovered quickly after operation. There was no statistical difference in ejection fraction on 1 day, 1 month, 3 months, and 6-12 months after operation (P>0.05). No children died, and no other clinical event was found.ConclusionThe Ozaki technique of reconstructing a tricuspid aortic valve leaflet for the treatment of severe aortic regurgitation in children is effective in short term, and the persistence of its valve function remains to be determined in the long-term follow-up.
Patients with Takayasu arteritis combined with aortic valve disease often have a poor prognosis following surgical valve replacement, frequently encountering complications such as perivalvular leakage, valve detachment, and anastomotic aneurysm. This article presents a high-risk case wherein severe aortic valve insufficiency associated with Takayasu arteritis was successfully managed through transcatheter aortic valve implantation via the transapical approach. The patient had satisfactory valve function with no complications observed during the six-month postoperative follow-up period. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.
ObjectiveTo evaluate the midterm effect of valve-sparing aortic root replacement (VSRR) on aortic root aneurysm and moderate to severe aortic regurgitation (AR). MethodsThe clinical data of patients with aortic root aneurysm and moderate to severe AR undergoing VSRR and surviving from the operation from October 2013 to May 2020 were retrospectively analyzed. There were 31 males and 9 females, with an average age of 47.1±13.4 years. There were 30 patients with true aneurysm of aortic root and 10 patients with dissecting aneurysm of aortic root. There were 3 patients with bicuspid aortic valve, and 12 patients with Marfan syndrome. The AR measured by the echocardiogram was moderate in 18 patients and severe in 22 patients. The average diameter of aortic annulus was 27.0±3.9 mm, and the mean largest diameter of aortic sinus was 52.3±6.1 mm. ResultsA total of 32 patients underwent David technique and 8 patients underwent Yacoub technique, and 10 patients underwent aortic cusp repair simultaneously. All 40 patients completed the follow-up, and the follow-up period was 12-86 (45.7±18.9) months. During the period, 1 patient died of heart failure, 2 had reoperation due to new-onset Stanford B aortic dissection, and no patients had reoperation related to aortic valve. The postoperative New York Heart Association cardiac function classification (1.6±0.5 vs. 2.8±0.8), left ventricular end-diastolic dimension (52.2±7.8 mm vs. 61.4±10.6 mm) and left ventricular end-diastolic volume (136.0±58.8 mL vs. 193.3±83.9 mL) of the patients were significantly improved compared with preoperative ones (P<0.05). By echocardiography, 19 patients had no AR, 18 patients had mild AR, 3 patients had mild-moderate AR, and no patients had moderate or higher AR. ConclusionIn patients with aortic root aneurysm and moderate to severe AR, VSRR technique avoids prosthetic valves and anticoagulation-related complications, has lower rate of AR recurrence and reoperation, and improves the quality of life in the midterm period.
ObjectiveTo summarize and analyze the risk factors and management of artificial valve slippage in transcatheter aortic valve implantation (TAVI).MethodsWe retrospectively analyzed the clinical data of 131 patients undergoing TAVI surgery in our center from September 2017 to May 2019, including 62 patients through transapical approach and 69 patients through transfemoral artery approach.ResultsA total of 131 patients received TAVI surgery, among whom 4 patients had slipped during the operation, 2 patients via transfemoral artery approach, and another 2 patients via transapical. The average age was 77±9 years with one female (25%). Preoperative evaluation, higher position and poor coaxial were main risk factors for valve slip in TAVI.ConclusionValve slippage is also a serious complication in TAVI surgery. Reasonable and effective treatment can avoid thoracotomy.
A 71-year-old male presented with esophageal cancer and severe aortic valve regurgitation. Treatment strategies for such patients are controversial. Considering the risks of cardiopulmonary bypass and potential esophageal cancer metastasis, we successfully performed transcatheter aortic valve implantation and minimally invasive three-incision thoracolaparoscopy combined with radical resection of esophageal cancer (McKeown) simultaneously in the elderly patient who did not require neoadjuvant treatment. This dual minimally invasive procedure took 6 hours and the patient recovered smoothly without any surgical complications.
Objective To evaluate the early clinical effect of reimplantation in the treatment of bicuspid aortic valve (BAV) with aortic root aneurysm. Methods The clinical data of 25 patients with BAV and aortic root aneurysm[mean diameter: 45-63 (52.68±5.55) mm] undergoing reimplantation in West China Hospital from November 2019 to May 2021 were retrospectively reviewed. There were 22 males and 3 females. The mean age was 15-65 (50.00±13.10) years and body surface area was 1.79±0.23 m2. ResultsThe pathological classification of BAV malformation was confirmed during the operation: Type 0 in 3 patients and Type 1 in 22 patients. There were 12 patients undergoing cusp central plication, and 2 patients were sutured with a closed fusion crest. Postoperative valve leaflet coaptation height was 0.78±0.15 cm, and effective height was 1.27±0.19 cm. In operation, maximum aortic valve flow velocity was 1.65±0.42 m/s, pressure difference was 5.46±3.05 mm Hg, and aortic valve annulus diameter was 21.32±0.95 mm. Cardiopulmonary bypass time was 225.84±35.34 min, and aortic block time was 189.60±26.51 min. In-hospital time was 11.64±3.07 d, ICU stay time was 2.64±0.99 d, and mechanical ventilation time was 1.48±0.87 d. The follow-up time was 17.20±4.70 months, and no death or major complications occurred during the follow-up in all patients. The cardiac function of the patients significantly improved postoperatively (P≤0.05). Echocardiography suggested that 12 patients had no aortic regurgitation, 10 minor aortic regurgitation, 3 mild aortic regurgitation, and no patients with moderate or more severe regurgitation. The diameter of the aortic sinus, left ventricular end-diastolic diameter and volume decreased during the follow-up, compared to preoperative ones (P≤0.05). The maximum flow velocity of the aortic valve was 1.54±0.36 m/s, and the pressure difference was 5.17±2.38 mm Hg during the follow-up. ConclusionReimplantation technology has a good clinical effect for highly selective BAV patients. It can effectively avoid long-term postoperative anticoagulation, but the maximum flow rate after surgery is slightly increased, which may be related to the configuration of BAV itself. While compared with valve replacement, the effect is still worthy of recognition.
ObjectiveTo explore the risk factors for 24-hour death in acute type A aortic dissection (ATAAD) patients with conservative treatment.MethodsFrom January 2009 to January 2018, 243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital, including 167 males and 76 females with an average age of 53.0±12.0 years. The risk factors for 24-hour mortality were analyzed.ResultsThe total in-hospital mortality rate was 37.9% (93/243), and 13.6% (33/243) patients died within 24 hours of onset. We found that left ventricular end diastolic diameter [LVEDD, OR=0.45, 95%CI (0.25, 0.83), P<0.01] and aortic regurgitation [OR=7.26, 95%CI (1.67, 31.53), P<0.01] were independent risk factors for 24-hour death in patients with ATAAD.ConclusionIn this study, LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients. Therefore, patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.
ObjectiveTo evaluate the short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves (BAV).MethodsThe clinical data of 27 consecutive patients with insufficient BAV undergoing valve repair in Shanghai Chest Hospital from September 2016 to January 2020 were retrospectively reviewed. There were 24 males and 3 females with a mean age of 38.5±14.6 years (range: 20-68 years). BAV of all patients was type 1 in Seviers' classification. There were 23 patients with left-right fusion and 4 patients with right-noncoronary fusion. There was aortic regurgitation in the patients measured by the echocardiogram, including moderate regurgitation in 3 patients, moderate-severe in 18 patients, and severe in 6 patients. The diameter of aortic annular base was 27.9±3.4 mm, and the largest diameter of aortic sinus was 39.9±7.6 mm. Left ventricular end diastolic diameter was 62.7±6.5 mm, and the volume was 197.9±53.6 mL.ResultsAll 27 patients completed the follow-up, and the mean time was 24.2±12.5 months (range: 12-51 months). No patient died or required aortic valve-related reoperation during the follow-up. The cardiac function of the patients significantly improved postoperatively (P<0.05). By echocardiography, 11 patients had no aortic regurgitation, 13 had mild aortic regurgitation, and 3 had moderate aortic regurgitation, and no patient had severe aortic regurgitation. Postoperative left ventricular end diastolic diameter and volume decreased, compared to preoperative ones (P<0.05).ConclusionIn patients with insufficient BAV, valve repair is safe and effective, and has excellent short and mid-term outcomes.
Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.