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History, Techniques, and Outcomes of the Remodeling Method

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Abstract

Since the two valve-sparing root replacement procedures of aortic root remodeling and aortic valve reimplantation were introduced, they have rapidly gained attention in recent years. Both types have their advantages and disadvantages, and it is difficult to say which one is superior in general. They are compared in the section “ONE-POINT ADVICE: Experimental Comparison Between the Reimplantation Method and Remodeling Method” (Chap. 17).

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References

  1. Wheat MW Jr, Wilson JR, Bartley TD. Successful replacement of the entire ascending aorta and aortic valve. JAMA. 1964;188:717–9.

    Article  PubMed  Google Scholar 

  2. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968;23:338–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Davies H, Lessof MH, Roberts CI, Ross DN. Homograft replacement of the aortic valve: follow-up studies in twelve patients. Lancet. 1965;1:926–9.

    Article  CAS  PubMed  Google Scholar 

  4. Sievers HH, Lange PE, Bernhard A. Implantation of a xenogeneic stentless aortic bioprosthesis. First experience. Thorac Cardiovasc Surg. 1985;33:225–6.

    Article  CAS  PubMed  Google Scholar 

  5. De Paulis R, Scaffa R, Maselli D, Weltert L, Salica A, Bellisario A. Valsalva graft in the Bentall procedure: from mechanical valve to the BioValsalva, world’s first biological aortic conduit. Surg Technol Int. 2008;17:216–21.

    PubMed  Google Scholar 

  6. David TE, Feindel CM. An aortic-valve sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–22.

    CAS  PubMed  Google Scholar 

  7. Sarsam MA, Yacoub M. Remodeling of the aortic anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.

    CAS  PubMed  Google Scholar 

  8. David TE. Aortic root aneurysms: remodeling or composite replacement? Ann Thorac Surg. 1997;64:1564–8.

    Article  CAS  PubMed  Google Scholar 

  9. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation. 2010;121:e266–369.

    PubMed  Google Scholar 

  10. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012;33:2451–96.

    Article  PubMed  Google Scholar 

  11. Kunihara T, Aicher D, Rodionycheva S, Groesdonk HV, Langer F, Sata F, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.

    Article  PubMed  Google Scholar 

  12. Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123:178–85.

    Article  PubMed  Google Scholar 

  13. Schäfers HJ, Schmied W, Marom G, Aicher D. Cusp height in aortic valves. J Thorac Cardiovasc Surg. 2013;146:269–74.

    Article  PubMed  Google Scholar 

  14. Hanke T, Charitos EI, Stierle U, Robinson D, Gorski A, Sievers HH, et al. Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery. J Thorac Cardiovasc Surg. 2009;137:314–9.

    Article  PubMed  Google Scholar 

  15. David TE, Maganti M, Armstrong S. Aortic root aneurysm: principles of repair and long-term follow-up. J Thorac Cardiovasc Surg. 2010;140:S14–9.

    Article  PubMed  Google Scholar 

  16. Benedetto U, Melina G, Takkenberg JJ, Roscitano A, Angeloni E, Sinatra R. Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis. Heart. 2011;97:955–8.

    Article  PubMed  Google Scholar 

  17. Coselli JS, Volguina IV, Lemaire SA, Sundt TM, Connolly HM, Stephens EH, et al. Aortic Valve Operative Outcomes in Marfan Patients Study Group. Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: a prospective, multicenter, comparative study. J Thorac Cardiovasc Surg. 2014;147:1758–67.

    Article  PubMed  Google Scholar 

  18. Svensson LG, Pillai ST, Rajeswaran J, Desai MY, Griffin B, Grimm R, et al. Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement. J Thorac Cardiovasc Surg. 2016;151:764–71.

    Article  PubMed  Google Scholar 

  19. de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde JL, Noirhomme P, et al. Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg. 2011;142:1430–8.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Beckmann E, Martens A, Pertz J, Kaufeld T, Umminger J, Hanke JS, Schmitto JD, Cebotari S, Haverich A, Shrestha ML. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Graeter TP, Fries R, Aicher D, Reul H, Schmitz C, Schäfers HJ. In-vitro comparison of aortic valve hemodynamics between aortic root remodeling and aortic valve reimplantation. J Heart Valve Dis. 2006;15:329–35.

    PubMed  Google Scholar 

  26. Fries R, Graeter T, Aicher D, Reul H, Schmitz C, Böhm M, et al. In vitro comparison of aortic valve movement after valve-preserving aortic replacement. J Thorac Cardiovasc Surg. 2006;132:32–7.

    Article  PubMed  Google Scholar 

  27. Leyh RG, Schmidtke C, Sievers HH, Yacoub MH. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999;100:2153–60.

    Article  CAS  PubMed  Google Scholar 

  28. Kunzelman KS, Grande KJ, David TE, Cochran RP, Verrier ED. Aortic root and valve relationships. Impact on surgical repair. J Thorac Cardiovasc Surg. 1994;107:162–70.

    CAS  PubMed  Google Scholar 

  29. Erasmi A, Sievers HH, Scharfschwerdt M, Eckel T, Misfeld M. In vitro hydrodynamics, cusp-bending deformation, and root distensibility for different types of aortic valve-sparing operations: remodeling, sinus prosthesis, and reimplantation. J Thorac Cardiovasc Surg. 2005;130:1044–9.

    Article  PubMed  Google Scholar 

  30. Matsumori M, Tanaka H, Kawanishi Y, Onishi T, Nakagiri K, Yamashita T, et al. Comparison of distensibility of the aortic root and cusp motion after aortic root replacement with two reimplantation techniques: Valsalva graft versus tube graft. Interact Cardiovasc Thorac Surg. 2007;6:177–81.

    Article  PubMed  Google Scholar 

  31. Wuliya M, Sleilaty G, Di Centa I, Khelil N, Berrebi A, Czitrom D, et al. An expansible aortic ring to preserve aortic root dynamics after aortic valve repair. Eur J Cardiothorac Surg. 2015;47:482–90.

    Article  PubMed  Google Scholar 

  32. Grande-Allen KJ, Cochran RP, Reinhall PG, Kunzelman KS. Re-creation of sinuses is important for sparing the aortic valve: a finite element study. J Thorac Cardiovasc Surg. 2000;119:753–63.

    Article  CAS  PubMed  Google Scholar 

  33. Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kunihara T. Valve-sparing aortic root surgery. CON: remodeling. Gen Thorac Cardiovasc Surg. 2017; https://doi.org/10.1007/s11748-017-0833-6.

    Article  PubMed  Google Scholar 

  35. Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg. 1998;115:1080–90.

    Article  CAS  PubMed  Google Scholar 

  36. El Khoury GA, Underwood MJ, Glineur D, Derouck D, Dion RA. Reconstruction of the ascending aorta and aortic root: experience in 45 consecutive patients. Ann Thorac Surg. 2000;70:1246–50.

    Article  CAS  PubMed  Google Scholar 

  37. Schäfers HJ, Raddatz A, Schmied W, Takahashi H, Miura Y, Kunihara T, et al. Reexamining remodeling. J Thorac Cardiovasc Surg. 2015;149:S30–6.

    Article  PubMed  Google Scholar 

  38. Pethig K, Milz A, Hagl C, Harringer W, Haverich A. Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure. Ann Thorac Surg. 2002;73:29–33.

    Article  PubMed  Google Scholar 

  39. Maselli D, De Paulis R, Scaffa R, Weltert L, Bellisario A, Salica A, et al. Sinotubular junction size affects aortic root geometry and aortic valve function in the aortic valve reimplantation procedure: an in vitro study using the valsalva graft. Ann Thorac Surg. 2007;84:1214–8.

    Article  PubMed  Google Scholar 

  40. Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg. 2000;119:975–82.

    Article  CAS  PubMed  Google Scholar 

  41. Lansac E, Di Centa I, Sleilaty G, Lejeune S, Berrebi A, Zacek P, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033–42.

    Article  PubMed  Google Scholar 

  42. de Kerchove L, Boodhwani M, Glineur D, Noirhomme P, El Khoury G. A new simple and objective method for graft sizing in valve-sparing root replacement using the reimplantation technique. Ann Thorac Surg. 2011;92:749–51.

    Article  PubMed  Google Scholar 

  43. Robicsek F, Thubrikar MJ, Cook JW, Fowler B. The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann Thorac Surg. 2004;77:177–85.

    Article  PubMed  Google Scholar 

  44. le Polain de Waroux JB, Pouleur AC, Robert A, Pasquet A, Gerber BL, Noirhomme P, et al. Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging. 2009;2:931–9.

    Article  PubMed  Google Scholar 

  45. Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8.

    Article  PubMed  Google Scholar 

  46. Bierbach BO, Aicher D, Issa OA, Bomberg H, Gräber S, Glombitza P, et al. Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg. 2010;38:400–6.

    Article  PubMed  Google Scholar 

  47. Furukawa K, Kamohara K, Yunoki J, Koga S, Itoh M, Morokuma H, Mukae Y, et al. Should the annulus be fixed in aortic valve-sparing root replacement with remodeling? Gen Thorac Cardiovasc Surg. 2017;65:200–5.

    Article  PubMed  Google Scholar 

  48. Erasmi AW, Sievers HH, Bechtel JF, Hanke T, Stierle U, Misfeld M. Remodeling or reimplantation for valve-sparing aortic root surgery? Ann Thorac Surg. 2007;83:S752–6.

    Article  PubMed  Google Scholar 

  49. Jeanmart H, de Kerchove L, Glineur D, Goffinet JM, Rougui I, Van Dyck M, et al. Aortic valve repair: the functional approach to leaflet prolapse and valve-sparing surgery. Ann Thorac Surg. 2007;83:S746–51.

    Article  PubMed  Google Scholar 

  50. Svensson LG, Batizy LH, Blackstone EH, Gillinov AM, Moon MC, D’Agostino RS, et al. Results of matching valve and root repair to aortic valve and root pathology. J Thorac Cardiovasc Surg. 2011;142:1491–8.e7.

    Article  Google Scholar 

  51. Charitos EI, Stierle U, Tietze C, Hanke T, Karluss A, Misfeld M, et al. Clinical outcomes and lessons learned with aortic valve repair in 508 patients. J Heart Valve Dis. 2014;23:550–7.

    PubMed  Google Scholar 

  52. David TE, Feindel CM, David CM, Manlhiot C. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg. 2014;148:872–9.

    Article  PubMed  Google Scholar 

  53. Price J, De Kerchove L, Glineur D, Vanoverschelde JL, Noirhomme P, El Khoury G. Risk of valve-related events after aortic valve repair. Ann Thorac Surg. 2013;95:606–12.

    Article  PubMed  Google Scholar 

  54. Arabkhani B, Mookhoek A, Di Centa I, Lansac E, Bekkers JA, De Lind Van Wijngaarden R, et al. Reported outcome after valve-sparing aortic root replacement for aortic root aneurysm: a systematic review and meta-analysis. Ann Thorac Surg. 2015;100:1126–31.

    Article  PubMed  Google Scholar 

  55. Kari FA, Doll KN, Hemmer W, Liebrich M, Sievers HH, Richardt D, et al. Residual and progressive aortic regurgitation after valve-sparing root replacement: a propensity-matched multi-institutional analysis in 764 patients. Ann Thorac Surg. 2016;101:1500–6.

    Article  PubMed  Google Scholar 

  56. Lansac E, Di Centa I, Sleilaty G, Bouchot O, Arnaud Crozat E, Blin D, et al. An aortic ring to standardise aortic valve repair: preliminary results of a prospective multicentric cohort of 144 patients. Eur J Cardiothorac Surg. 2010;38:147–54.

    Article  PubMed  Google Scholar 

  57. Aicher D, Schneider U, Schmied W, Kunihara T, Tochii M, Schäfers HJ. Early results with annular support in reconstruction of the bicuspid aortic valve. J Thorac Cardiovasc Surg. 2013;145:S30–4.

    Article  PubMed  Google Scholar 

  58. Schneider U, Feldner SK, Hofmann C, Schöpe J, Wagenpfeil S, Giebels C, et al. Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg. 2017;153:S65–71.

    Article  PubMed  Google Scholar 

  59. Patel ND, Weiss ES, Alejo DE, Nwakanma LU, Williams JA, Dietz HC, et al. Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures. Ann Thorac Surg. 2008;85:2003–10.

    Article  PubMed  Google Scholar 

  60. David TE, Armstrong S, Maganti M, Colman J, Bradley TJ. Long-term results of aortic valve-sparing operations in patients with Marfan syndrome. J Thorac Cardiovasc Surg. 2009;138:859–64.

    Article  PubMed  Google Scholar 

  61. Kunihara T, Aicher D, Rodionycheva S, Asano M, Tochii M, Sata F, et al. Outcomes after valve-preserving root surgery for patients with Marfan syndrome. J Heart Valve Dis. 2012;21:615–22.

    PubMed  Google Scholar 

  62. 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.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Takashi Kunihara

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  1. Takashi Kunihara
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Correspondence to Takashi Kunihara .

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Editors and Affiliations

  1. Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Takashi Kunihara

  2. Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Tokyo, Japan

    Shuichiro Takanashi

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Kunihara, T. (2019). History, Techniques, and Outcomes of the Remodeling Method. In: Kunihara, T., Takanashi, S. (eds) Aortic Valve Preservation. Springer, Singapore. https://doi.org/10.1007/978-981-13-2068-2_16

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  • DOI: https://doi.org/10.1007/978-981-13-2068-2_16

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