Étiquette : Aortic root

Vol. 20 JA2016 - cardiac

C-12 – Redo operations for aneurysm of ascending aorta after previous aortic valve replacement: a purpose of 17 cases
Hakim Himeur, Mourad Aouiche, Rym Bourezak, Abderazak Moussaoui, Rachid Ait Mohand, Chafik Bendamerdji, Salah Eddine Bourezak Institution : Service de chirurgie cardiovasculaire, EHS Mohamed-Abderrahmani, Bir Mourad Rais, Alger, Algérie Objectives : Five to fifteen percent of patient undergoing aortic valve replacement (AVR) will have an ascending aortic aneurysm requiring a concomitant surgical procedure. The aim of this study was to evaluate the early and late results for complex surgical procedure of the proximal aorta after previous aortic valve replacement (AVR). Methods : Between May 2004 to August 2016; 17 patients underwent ascending aortic replacement secondary to aortic valve surgery and mostly for aortic valve replacement (AVR). (12) Males and five (05) Females, mean age 42 years. Mono leaflet prosthesis (03), Starr (03), Double leaflet (06), Bioprosthesis (01), congenital aortic valve stenosis, wrapping of annulo-aortic ectasia (01). The mean time between the first procedure and redo surgery is 20 years. Results : The 30 days mortality rate is (2/17); emergency repair is associated with higher early mortality. The global survival with the Kaplan-meier method is 93% at 05 years. Conclusion : Redo surgery for aneurysm of ascending aorta is a major surgical challenge with high postoperative mortality. Patients are at risk for later dissection or rupture of the aortic wall. Elective re-operation for ascending aorta can be accomplished with acceptable mortality.
novembre 29, 2016
Vol. 20 JA2016 - cardiac

C-16 – Longterm outcomes after concomitant cardiac surgery and ascending aorta to bifemoral bypass
Côme Bosse, Ramzi Ramadan, Rémi Nottin, Dominique Fabre, Olaf Mercier, Philippe Deleuze, Julien Guihaire Institution : Service de chirurgie cardiaque adultes, centre chirurgical Marie-Lannelongue, Le Plessis-Robinson Objectives : A subset of patients referred for coronary artery bypass grafting (CABG) or valvular surgery present with sever leg ischemia from Cardiac diseases and aorto-iliac occlusion frequently coexist in the same patients. The ascending aorta has been reported as a being a good source ofgood inflow site for bifemoral bypass.We sought to investigate the post-operative outcomes and long-term patency of this prosthetic ventral aorta when combined with synchronous cardiac surgery combined with ascending aorta to bifemoral bypass. Methods : Seven patients with a mean age of 64 (47-75), underwent concomitant ventral aorta and of which 6 for CABG (n=6) or and 1 aortic valve replacement (n=1) , underwent surgery through median sternotomy between 2010 and 2016. After weaning from cardiopulmonary bypass, a dacron or PTFE prosthetic tube conduit (Dacron of PTFE, diameter 8 to 16 mm) was sutured to the ascending aorta and led to both femoral arteries, used and either as an Y bifemoral anastomosis graft or as a right femoral anastomosis graft associated with cross-femoral bypass was performed. Long-term graft patency was investigated by physical examination and CT angiogram. Results : Five (71%) patients were Leriche stage 2B and had a 54% mean left ventricular functionheart function preoperatively. 5 patients underwent the Y bifemoral approach and 2 patients had a right aorto-femoral bypass combined with cross-femoral bypass. No perioperative deaths and no major complications related to the prosthetic ventral aorta occurred. Average length of stay was 12 days (4-19). Mean follow-up was 23 months (1-66). At five years, all grafts were patent except for one distal left branch. Conclusion : In patients with concomitant cardiac disease and aorto-iliacdiseases chronic occlusion, ascending aorta to bifemoral bypass combined with cardiac surgery is a safe strategy providing favorable outcomes.
novembre 29, 2016
Chirurgie cardiaque congénitale et pédiatrique · Vol. 20 Abstract 2016

P-03 – La voie gauche après un switch artériel : intérêt de la conservation de la géométrie du néoculot aortique
Célia Gran, Virginie Fouilloux, Caroline Ovaert, Fedoua El Louali, Julie Berbis, Caroline Chenu, Philippe Aldebert, Dominique Metras, Loïc Mace, Bernard Kreitmann Service médico-chirurgical de cardiologie pédiatrique et congénitale, hôpital de la Timone-enfants, AP-HM, Marseille  Objectif Le but de cette étude est d’examiner l’évolution à long terme de la voie de sortie du ventricule gauche chez les patients opérés d’un switch artériel.  Méthode Nous avons analysé rétrospectivement 271 patients ayant bénéficié d’un switch artériel dans notre service entre janvier 1985 et décembre 2008. Les données anatomiques et la technique chirurgicale utilisée ont été recueillies. Le but, lors du switch artériel, était de préserver la jonction sino-tubulaire et de réaliser une anastomose directe des coronaires en bouton dès que cela était possible afin de conserver la géométrie du néoculot aortique. Les données échographiques, de scanner et/ou IRM ont été analysées.  Résultat L’âge médian lors du switch artériel était de 10 jours (1-497). 75,6 % (n = 205) étaient de sexe masculin. La durée moyenne de suivi était de 12,12 ± 6,62 ans (maximum 29,82 ans). Une réimplantation directe sans trap-door pour les 2 coronaires a été réalisée dans 60 % des cas. Deux décès de causes cardiaques sont survenus (0,7 %). Le Z-score moyen mesuré au niveau du sinus de Valsalva était de + 3,72 DS (diamètre moyen de 42,4 mm chez les adultes). Une dilatation du néoculot aortique (Z-score > +3DS ou diamètre maximum du segment 0 > 40 mm) a été retrouvée chez 57 patients (22,7 %). La durée de suivi et le sexe masculin étaient significativement associés à la survenue d’une dilatation aortique. Une insuffisance aortique modérée était retrouvée chez seulement 5 patients et aucun n’avait de régurgitation sévère. Aucun facteur de risque significatif n’a pu être identifié. Il n’y a pas eu d’événement aortique ou coronaire aigu et seul 1 patient a nécessité une réintervention sur la voie gauche (sténose sous-valvulaire aortique).  Conclusion Par comparaison aux données de la littérature, nos résultats montrent une très faible incidence d’insuffisance aortique ou de dilatation du néoculot aortique significatives, sans nécessité de réintervention. Conserver au maximum la géométrie du néoculot aortique lors de la réimplantation coronaire est probablement une des façons de diminuer leur incidence et est possible sans augmenter le risque coronaire.     The left ventricular outflow tract after arterial switch operation- the benefit of geometry preservation   Objectives The aim of this report is to examine the long-term outcome of the LVOT after ASO.  Methods We retrospectively studied 271 patients who underwent ASO between January 1985 and December 2008 in our institution. Anatomic data and surgical procedure details were collected. The aim of the surgery was to preserve the neo-aorta sino-tubular junction and to use direct coronary reimplantation, whenever possible. The geometry of the neo-aortic root was as a result, mostly preserved. Echocardiographic data, and MRI or CT-scan follow-up data were collected and analyzed.  Results Median age at time of ASO was 10 days (1-497). 75.6% (n=205) were male. Follow up reached 12.12±6.62 years (maximum 29.82 years). Direct reimplantation without any trap door technique was done in 60% of the cases. Two deaths from cardiac causes (0.7%) were encountered. Mean Valsalva sinus diameter Z-score was +3.72 (42.4 mm for adults). An aortic root Z-score >3 or diameter >40 mm (in adults) was found in 57 patients (22.7%). Length of follow-up and male gender were significantly associated with aortic dilatation. Moderate aortic insufficiency was seen in only 5 patients and none had severe regurgitation. No significant risk factor for aortic insufficiency could be identified. There were no aortic or coronary events and only one patient required an elective LVOT surgery (subvalvar stenosis).  Conclusion Our results, when compared to other literature data, show a very low incidence of significant aortic regurgitation or dilatation of the neo-aortic root, with no re-intervention. Our effort to conserve geometry during coronary reimplantation is probably part of the way to lower the incidence of root dilation and aortic insufficiency and is possible without increasing coronary risk.
juin 10, 2016