PMID- 31240180
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 2225-319X (Print)
IS  - 2304-1021 (Electronic)
IS  - 2225-319X (Linking)
VI  - 8
IP  - 3
DP  - 2019 May
TI  - Multimodal imaging of aortic annulus and root geometry after valve sparing root 
      reconstruction.
PG  - 362-371
LID - 10.21037/acs.2019.05.09 [doi]
AB  - BACKGROUND: Controversy exists regarding the optimal annular stabilization 
      technique following valve sparing aortic root reconstruction (VSRR) with no 
      comprehensive imaging data to evaluate the natural history of aortic root graft 
      geometry, aortic valve competency and patient prognosis post-reconstruction. 
      METHODS: Between 2008-2017, 70 consecutive patients (mean age 56.4+/-16.4 years, 
      19.7% females) underwent VSRR. All patients were prospectively evaluated annually 
      with clinical follow-up, echocardiography and CT imaging. Patients were assessed 
      for survival, freedom from reoperation, degree of regurgitation, New York Heart 
      Association (NYHA) status and graft complications and followed up to nine years 
      post-operatively (mean 36+/-21 months). RESULTS: The largest increase of the aortic 
      annulus diameter observed during the surveillance period was 2.64%+/-5.4% which 
      occurred between the second and third years of follow-up and the aortic sinuses, 
      sinotubular junction and ascending aorta all remained relatively stable based on 
      annual CT imaging. Echocardiographic data showed far more variability in 
      measurements at each annual post-operative visit with far less precision compared 
      to the CT measurements taken at the same time. Due to the large variability and 
      greater standard deviations, no significant difference was detected between the 
      more precise CT measurements and those from the echocardiogram images. The 
      overall survival rate was 94.3% (66 patients) at one year. Freedom from 
      reoperation was 98.6% (69 patients). Throughout the entire duration of follow-up, 
      aortic insufficiency was identified as 0 in 46 (65.7%), 1+ in 19 (27.1%), 2+ in 4 
      (5.7%), 3+ in 0 (0%) and 4+ in 1 (1.4%). Mean NYHA status was 1.1+/-0.3 at most 
      recent follow-up for all patients. CT evidence showed 97.0% (64 patients) freedom 
      from graft complication including: endocarditis, thrombosis, embolism, aneurysm, 
      pseudoaneurysm, dehiscence, dissection and kinking. CONCLUSIONS: The annual 
      imaging data presented here demonstrates stability of the Dacron aortic 
      annuloplasty reconstruction over time, without the need for internal or external 
      annular stabilization. CT imaging proved to be far more reliable than 
      echocardiographic images, however given the stability, annual CT imaging is of 
      little benefit. This is the first prospective study to compare echocardiographic, 
      CT and clinical data following VSRR.
FAU - Valdis, Matthew
AU  - Valdis M
AD  - Division of Cardiac Surgery, Department of Surgery, Western University, London 
      Health Sciences Centre, London, Ontario, Canada.
FAU - Thain, Andrew
AU  - Thain A
AD  - Division of Cardiology, Department of Medicine, Western University, London Health 
      Sciences Centre, London, Ontario, Canada.
FAU - Jones, Philip M
AU  - Jones PM
AD  - Department of Anesthesia & Perioperative Medicine, Western University, London 
      Health Sciences Centre, London, Ontario, Canada.
AD  - Department of Epidemiology & Biostatistics, Western University, London Health 
      Sciences Centre, London, Ontario, Canada.
FAU - Chan, Ian
AU  - Chan I
AD  - Department of Radiology, Western University, London Health Sciences Centre, 
      London, Ontario, Canada.
FAU - Chu, Michael W A
AU  - Chu MWA
AD  - Division of Cardiac Surgery, Department of Surgery, Western University, London 
      Health Sciences Centre, London, Ontario, Canada.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Ann Cardiothorac Surg
JT  - Annals of cardiothoracic surgery
JID - 101605877
PMC - PMC6562094
OTO - NOTNLM
OT  - Valve sparing
OT  - aortic annulus
OT  - cardiac imaging
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2019/06/27 06:00
MHDA- 2019/06/27 06:01
PMCR- 2019/05/01
CRDT- 2019/06/27 06:00
PHST- 2019/06/27 06:00 [entrez]
PHST- 2019/06/27 06:00 [pubmed]
PHST- 2019/06/27 06:01 [medline]
PHST- 2019/05/01 00:00 [pmc-release]
AID - acs-08-03-362 [pii]
AID - 10.21037/acs.2019.05.09 [doi]
PST - ppublish
SO  - Ann Cardiothorac Surg. 2019 May;8(3):362-371. doi: 10.21037/acs.2019.05.09.