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Valve-Sparing Aortic Root Replacement to Treat Acute Type A Aortic Dissection

  • Hiroyuki KamiyaEmail author
Chapter

Abstract

The main forms of proximal operation to treat type A aortic dissection are (1) supracoronary aortic replacement, (2) aortic root replacement (ARR; Bentall procedure), (3) valve-sparing aortic root replacement (VSARR; David procedure, hereinafter referred to as reimplantation), and (4) VSARR (Yacoub procedure, hereinafter referred to as remodeling). If neither aortic root dilatation nor dissection in any of the sinuses of Valsalva is observed, and the patient does not suffer from aortic stenosis (AS) or regurgitation (AR), then supracoronary aortic replacement is considered to be the most appropriate form of surgery. In many cases, however, dissection has extended to the aortic root, and therefore, the surgical technique must be selected on the basis of the individual case.

References

  1. 1.
    Bachet J, Goudot B, Teodori G, Brodaty D, Dubois C, De Lentdecker P, et al. Surgery of type A acute aortic dissection with Gelatine-Resorcine-Formol biological glue: a twelve-year experience. J Cardiovasc Surg. 1990;31:263–73.Google Scholar
  2. 2.
    Casselman FP, Tan ES, Vermeulen FE, Kelder JC, Morshuis WJ, Schepens MA. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg. 2000;70:1227–33.CrossRefGoogle Scholar
  3. 3.
    Fukunaga S, Karck M, Harringer W, Cremer J, Rhein C, Haverich A. The use of gelatin-resorcin-formalin glue in acute aortic dissection type A. Eur J Cardiothorac Surg. 1999;15:564–9.CrossRefGoogle Scholar
  4. 4.
    Modi A, Bull R, Tsang G, Kaarne M. Ostial left coronary stenosis following aortic root reconstruction with BioGlue. Interact Cardiovasc Thorac Surg. 2011;13:243–5.CrossRefGoogle Scholar
  5. 5.
    Pacini D, Ranocchi F, Angeli E, Settepani F, Pagliaro M, Martin-Suarez S, et al. Aortic root replacement with composite valve graft. Ann Thorac Surg. 2003;76:90–8.CrossRefGoogle Scholar
  6. 6.
    Subramanian S, Leontyev S, Borger MA, Trommer C, Misfeld M, Mohr FW. Valve-sparing root reconstruction does not compromise survival in acute type A aortic dissection. Ann Thorac Surg. 2012;94:1230–4.CrossRefGoogle Scholar
  7. 7.
    Kallenbach K, Oelze T, Salcher R, Hagl C, Karck M, Leyh RG, et al. Evolving strategies for treatment of acute aortic dissection type A. Circulation. 2004;110(11 Suppl 1):II243–9.PubMedGoogle Scholar
  8. 8.
    Leyh RG, Fischer S, Kallenbach K, Kofidis T, Pethig K, Harringer W, et al. High failure rate after valve-sparing aortic root replacement using the “remodeling technique” in acute type A aortic dissection. Circulation. 2002;106:I229–33.PubMedGoogle Scholar
  9. 9.
    Urbanski PP, Hijazi H, Dinstak W, Diegeler A. Valve-sparing aortic root repair in acute type A dissection: how many sinuses have to be repaired for curative surgery? Eur J Cardiothorac Surg. 2013;44:439–44.CrossRefGoogle Scholar
  10. 10.
    Kunihara T, Neumann N, Kriechbaum SD, Aicher D, Schäfers HJ. Aortic root remodeling leads to good valve stability in acute aortic dissection and preexistent root dilatation. J Thorac Cardiovasc Surg. 2016;152:430–6.CrossRefGoogle Scholar
  11. 11.
    Schäfers HJ, Raddatz A, Schmied W, Takahashi H, Miura Y, Kunihara T, et al. Reexamining remodeling. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S30–6.CrossRefGoogle Scholar
  12. 12.
    Kunihara T, Neumann N, Kriechbaum SD, Nomura R, Schäfers HJ. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J. 2017;81:1824–31.CrossRefGoogle Scholar
  13. 13.
    Shahriari A, Eng M, Tranquilli M, Elefteriades JA. Rescue coronary artery bypass grafting (CABG) after aortic composite graft replacement. J Card Surg. 2009;24:392–6.CrossRefGoogle Scholar
  14. 14.
    Di Eusanio M, Trimarchi S, Peterson MD, Myrmel T, Hughes GC, Korach A, et al. Root replacement surgery versus more conservative management during type A acute aortic dissection repair. Ann Thorac Surg. 2014;98:2078–84.CrossRefGoogle Scholar
  15. 15.
    Leshnower BG, Myung RJ, McPherson L, Chen EP. Midterm results of David V valve-sparing aortic root replacement in acute type A aortic dissection. Ann Thorac Surg. 2015;99:795–800.CrossRefGoogle Scholar
  16. 16.
    Beckmann E, Martens A, Pertz J, Kaufeld T, Umminger J, Hanke JS, et al. Valve-sparing David I procedure in acute aortic type A dissection: a 20-year experience with more than 100 patients. Eur J Cardiothorac Surg. 2017;52:319–24.CrossRefGoogle Scholar
  17. 17.
    Conzelmann LO, Weigang E, Mehlhorn U, Abugameh A, Hoffmann I, Blettner M, et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg. 2016;49(2):e44–52.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Cardiac SurgeryAsahikawa Medical UniversityAsahikawaJapan

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