PMID- 15336989
OWN - NLM
STAT- MEDLINE
DCOM- 20050711
LR  - 20181130
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 78
IP  - 3
DP  - 2004 Sep
TI  - Results of aortic valve-sparing operations: experience with remodeling and 
      reimplantation procedures in 65 patients.
PG  - 767-72; discussion 767-72
AB  - BACKGROUND: Valve-sparing operations for aortic root aneurysms are increasing in 
      frequency, but techniques and results are still in evolution. We reviewed our 
      experience with 65 patients (adults and children) who had this operation at our 
      institution to determine early and late outcomes. METHODS: A retrospective 
      clinical review was undertaken using hospital records, clinical and 
      echocardiographic, computed tomography, magnetic resonance imaging data, and 
      telephone interviews with patients and their physicians. RESULTS: Between July 
      1994 and December 2002, 65 patients (46 adults and 19 children) underwent a 
      valve-sparing operation for aortic root aneurysm. Forty-four of the patients had 
      the Marfan syndrome; the remaining 21 had either a nonspecific connective tissue 
      disorder (14 patients) or a miscellaneous disease process such as Ehlers-Danlos 
      syndrome (7 patients). Fifty-eight (89%) had a David II (remodeling) procedure 
      and 7 had a David I (reimplantation) procedure. The DePaulis "Valsalva graft" was 
      used in six of the David I patients. There were no operative or hospital deaths; 
      only one late death occurred in an adult due to salmonella meningitis. Overall, 
      survival was 100% at one year and 98% at 3 and 5 years. Ten patients (7 adults 
      and 3 children) developed significant late aortic insufficiency (AI). Nine of 
      these patients had a David II procedure and in 8 of these cases, AI was secondary 
      to significant late annular dilatation. One of the 10 patients developed late AI 
      8.2 years after a David I procedure; his AI was secondary to aortic leaflet 
      extension and prolapse. Six of the 10 patients who developed significant late AI 
      required aortic valve replacement (4 adults and 2 children). Freedom from late 
      aortic valve replacement (AVR) in this series of 65 patients was 91% at 3 and 84% 
      at 5 years. At the close of this study, 58 patients were New York Heart 
      Association (NYHA) class I and 6 were NYHA class II; no patients were class III 
      or IV. There were no episodes of endocarditis or clinically significant 
      thromboembolism. CONCLUSIONS: Valve-sparing operations provide satisfactory 
      results for many patients with an aortic root aneurysm, but the David II 
      remodeling procedure has a greater risk of late annular dilatation and AI. The 
      David I reimplantation procedure utilizing the DePaulis Valsalva graft may 
      obviate this problem.
FAU - Bethea, Brian T
AU  - Bethea BT
AD  - Division of Cardiac Surgery, Institute of Genetic Medicine, Johns Hopkins 
      University School of Medicine, Baltimore, MD 21287, USA.
FAU - Fitton, Torin P
AU  - Fitton TP
FAU - Alejo, Diane E
AU  - Alejo DE
FAU - Barreiro, Christopher J
AU  - Barreiro CJ
FAU - Cattaneo, Stephen M
AU  - Cattaneo SM
FAU - Dietz, Harry C
AU  - Dietz HC
FAU - Spevak, Philip J
AU  - Spevak PJ
FAU - Lima, Joao A C
AU  - Lima JA
FAU - Gott, Vincent L
AU  - Gott VL
FAU - Cameron, Duke E
AU  - Cameron DE
LA  - eng
GR  - R01-AR41135/AR/NIAMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antibiotic Prophylaxis
MH  - Aortic Aneurysm/complications/diagnosis/mortality/*surgery
MH  - Aortic Valve/diagnostic imaging/pathology
MH  - Aortic Valve Insufficiency/diagnosis/etiology/*prevention & control/therapy
MH  - Awards and Prizes
MH  - Child
MH  - Child, Preschool
MH  - Echocardiography
MH  - Endocarditis/etiology/*prevention & control
MH  - Female
MH  - Heart Valve Prosthesis/statistics & numerical data
MH  - Humans
MH  - Infant
MH  - Magnetic Resonance Angiography
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Thromboembolism/etiology/prevention & control
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
EDAT- 2004/09/01 05:00
MHDA- 2005/07/12 09:00
CRDT- 2004/09/01 05:00
PHST- 2004/03/16 00:00 [accepted]
PHST- 2004/09/01 05:00 [pubmed]
PHST- 2005/07/12 09:00 [medline]
PHST- 2004/09/01 05:00 [entrez]
AID - S0003497504006952 [pii]
AID - 10.1016/j.athoracsur.2004.03.040 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2004 Sep;78(3):767-72; discussion 767-72. doi: 
      10.1016/j.athoracsur.2004.03.040.