| Early results of valve-sparing aortic root replacement in high-risk clinical scenarios. | |
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MedLine Citation:
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PMID: 20103323 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The feasibility of valve-sparing aortic root procedures (David) in certain high-risk situations has been questioned. We sought to determine the safety of the David procedure in the following high-risk subgroups: acute type A dissection, severe aortic insufficiency (AI), and reoperations. METHODS: From 2005 through 2007, 110 root replacements were performed for the above criteria: 73 root replacements with a composite valve-conduit (Bentall) and 37 David procedures. The reimplantation technique was used in all 37 David patients, with 7 requiring aortic cusp repair. RESULTS: There were no significant differences in preoperative or intraoperative variables between the groups, with the exception of cross-clamp time, which was longer for David patients. There was a slight, but nonsignificant increase in mortality among Bentall patients (8.2% [6 of 73]) compared with David patients (5.4% [2 of 37], p = 0.59]. There were no differences with respect to postoperative stroke, renal failure, or respiratory failure. Predischarge echocardiogram in the surviving 35 David patients demonstrated no AI in 25 patients and trace/mild AI in 10. Freedom from AVR at a mean follow-up of 8.8 months (range, 1 to 40) was 94.3% (33 of 35). One patient required AVR because of endocarditis at 9 months, and 1 had severe AI 13 months postoperatively. CONCLUSIONS: Valve-sparing aortic root replacement can be performed safely in the setting of acute dissection, severe AI, and reoperations with acceptable early results. Long-term follow-up is needed to determine the durability of repair in these high-risk groups. |
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Authors:
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Faraz Kerendi; Robert A Guyton; J David Vega; Patrick D Kilgo; Edward P Chen |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 89 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-01-27 Completed Date: 2010-02-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 471-6; discussion 477-8 Citation Subset: AIM; IM |
Copyright Information:
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2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Cardiothoracic and Vascular Surgeons, Austin, Texas, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aneurysm, Dissecting / diagnosis, mortality, surgery* Aorta / surgery Aortic Aneurysm, Thoracic / diagnosis, mortality, surgery* Aortic Valve / surgery Aortic Valve Insufficiency / diagnosis, mortality, surgery* Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation* Comorbidity Echocardiography Female Follow-Up Studies Heart Valve Prosthesis Heart Valve Prosthesis Implantation* Humans Kaplan-Meiers Estimate Male Middle Aged Polyethylene Terephthalates Postoperative Complications / diagnosis, mortality, surgery Prosthesis Design Reoperation Risk Factors Survival Rate |
| Chemical | |
Reg. No./Substance:
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0/Polyethylene Terephthalates |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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