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Titel: Aortic Root Remodeling
VerfasserIn: Giebels, Christian
Ehrlich, Tristan
Schäfers, Hans-Joachim
Sprache: Englisch
Titel: Operative techniques in thoracic and cardiovascular surgery : a comparative atlas
Bandnummer: 23
Heft: 3
Seiten: 102-120
Verlag/Plattform: Elsevier
Erscheinungsjahr: 2023
Freie Schlagwörter: Root remodeling
Aortic root replacement
Aortic valve repair
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: Aortic root remodeling was originally designed in the late 1980s to treat patients with tricuspid aortic valves (TAVs), aortic regurgitation (AR), and root aneurysm to normalize root dimensions. The late results showed a relevant proportion of patients who required reoperation for recurrent AR. Later observations revealed that cusp prolapse is frequently present after correction of root dilatation. We showed that such prolapse could be detected by measuring effective height (eH) and corrected by concomitant cusp repair. In the past 13 years, we have added a suture annuloplasty to improve aortic valve function further. The operation starts with ascertaining adequate cusp size by measuring geometric cusp height. The dilated aortic wall is resected, and a Dacron graft is tailored to create three tongues. These tongues are sutured to the cusp insertion lines. Starting the suture in the nadir allows for easy extension of tongue length to avoid commissural height restriction. A suture annuloplasty is added at nadir level and tied around a Hegar dilator to normalize annular diameter. The valve is assessed visually and by measuring eH. Cusp prolapse (eH <9 mm) is frequent and corrected by free margin plication until all free margins are at equal level and eH is 9 mm. We have employed root remodeling in more than 710 instances of root aneurysm and TAVs. Mean myocardial ischemic time has been 65±13 minutes for isolated remodeling, operative mortality has been 1.5% for elective procedures. With suture annuloplasty, 10-year freedom from reoperation is 95%, even without suture annuloplasty 20-year freedom from reoperation is 85%. In our experience, root remodeling has been a valid form of valve-preserving surgery with low morbidity and mortality and excellent long-term results.
DOI der Erstveröffentlichung: 10.1053/j.optechstcvs.2019.03.001
URL der Erstveröffentlichung: https://www.sciencedirect.com/science/article/pii/S1522294218301193
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-434887
hdl:20.500.11880/38979
http://dx.doi.org/10.22028/D291-43488
ISSN: 1532-8627
1522-2942
Datum des Eintrags: 18-Nov-2024
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Chirurgie
Professur: M - Prof. Dr. Hans Joachim Schäfers
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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