Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Niguarda Cà Granda Hospital, Milan, Italy Italy Partial aortic root remodeling Partial aortic root remodeling with selective replacement of the non-coronary sinus: with selective replacement of the non-coronary sinus: does aortic valve morphology influence outcomes? does aortic valve morphology influence outcomes? L L , Cannata A, Bruschi G, Trunfio S, Merlanti B, Russo CF, Taglieri C, Martin
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Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
Partial aortic root remodeling Partial aortic root remodeling with selective replacement of the non-coronary sinus: with selective replacement of the non-coronary sinus: does aortic valve morphology influence outcomes?does aortic valve morphology influence outcomes?
Botta LBotta L, Cannata A, Bruschi G, Trunfio S, Merlanti B, Russo CF, Taglieri C, Martinelli L.
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
These aneurysms begin in the ascending aorta and extend into the root and arch. The pattern of root dilation is determined by pressure and flow characteristics. The sinotubular junction (STJ) enlarges first followed by the noncoronary and right coronary sinuses. Though the annulus remains stable, the respective valve cusps are retracted and splayed producing central aortic regurgitation. The left coronary sinus usually retains normal dimensions until a very advanced stage, except in patients with sitis inversus where the left sinus dilates first.
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus Replacement
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
MATERIALS and METHODSMATERIALS and METHODS
APRIL 2003- OCTOBER 2009APRIL 2003- OCTOBER 2009
29 PATIENTS29 PATIENTS
Ascending Aorta and Isolated Non-Coronary Sinus Replacement
Tricuspid valve:
16 Pts (13 Males, Mean Age 65 ± 11 y)
Bicuspid valve:
13 Pts (11 Males, Mean Age 52 ± 12 y)
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus Replacement
Pre-operative FeaturesPre-operative Features
ETIOLOGYAORTIC ROOT ANEURYSM 13 pts RUPTURED ANEURYSM 0 ptsACUTE TYPE A DISSECTION 0 ptsPSEUDOANEURYSM 0 pts
13 pts
Asc Ao and NC Sinus Rep
16 pts
Asc Ao and NC Sinus Rep
ETIOLOGYAORTIC ROOT ANEURYSM 14 pts RUPTURED ANEURYSM 1 ptACUTE TYPE A DISSECTION 0 ptsPSEUDOANEURYSM 1 pts
REDO 3 pts REDO 4 pts
Mean Aortic Diameter 52.7 mm Mean Aortic Diameter 52.2 mm
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
Intra-operative DataIntra-operative Data
Ascending Aorta and Isolated Non-Coronary Sinus Replacement
- CPB time: 147 + 60 min- Cross Clamp Time 118 + 53 min
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
IN-HOSPITAL OUTCOMESIN-HOSPITAL OUTCOMES
Ascending Aorta and Isolated Non-Coronary Sinus Replacement
Post-Operative stay: 7 Days (median)Post-Operative stay: 7 Days (median)
30 days MORTALITY: 0 pts30 days MORTALITY: 0 pts
30 days MORBIDITY30 days MORBIDITY- Stroke 1pt- Stroke 1pt- Renal/Respiratory Failure 1pt- Renal/Respiratory Failure 1pt
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
FOLLOW-UPFOLLOW-UP
LATE MORTALITY: 0 ptsLATE MORTALITY: 0 pts
Mean: 27.3 monthsMean: 27.3 months
Ascending Aorta and Isolated Non-Coronary Sinus Replacement
LATE MORBIDITY: 0 ptsLATE MORBIDITY: 0 pts
AORTIC DISSECTION: 0 ptsAORTIC DISSECTION: 0 pts
RE-OPERATIONS: 0 ptsRE-OPERATIONS: 0 pts
Mean: 32.3 monthsMean: 32.3 months
100% completed
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
When dilatation of the aortic root is confined to theWhen dilatation of the aortic root is confined to theNon-coronary sinus of Valsalva, the selective replacementNon-coronary sinus of Valsalva, the selective replacementof this sinus may represent a good compromise, with of this sinus may represent a good compromise, with excellent early and midterm outcomes.excellent early and midterm outcomes.
In patients with a bicuspid aortic valve, risk of aortic In patients with a bicuspid aortic valve, risk of aortic related adverse events is rare and similar to that of related adverse events is rare and similar to that of patients with a tricuspid valve.patients with a tricuspid valve.
CONCLUSIONS
More patients and a longer follow-up is mandatory to More patients and a longer follow-up is mandatory to confirm these preliminary results.confirm these preliminary results.
Luca Botta MD, Cardiac Surgery Unit Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, ItalyNiguarda Cà Granda Hospital, Milan, Italy
