Results of Aortic Valve-Sparing and Restoration With Autologous Pericardial Leaflet Extensions in Congenital Heart Disease  Jonah Odim, MD, PhD, MBA,

Slides:



Advertisements
Similar presentations
Late Surgical Explantation and Aortic Valve Replacement After Transcatheter Aortic Valve Implantation  Louis W. Wang, MBBS, MM, Emily K. Granger, MBBS,
Advertisements

Hans-H. Sievers, MD, Claudia Schmidtke, MD, MBA 
The Completion Bentall Procedure
Edward H. Kincaid, MD, Neal D. Kon, MD 
Surgical Correction of Congenital Supravalvular Aortic Stenosis
Long-Term Experience of Girdling the Ascending Aorta With Dacron Mesh as Definitive Treatment for Aneurysmal Dilation  Oved Cohen, MD, Jonah Odim, MD,
Successful Repair of Regurgitant Pentacuspid Pulmonary Valve Combined With Pulmonary Artery Aneurysm  Tasuku Kadowaki, MD, Hiroki Yamaguchi, MD, PhD,
Surgical and Pathological Anatomy of the Aortic Valve and Root
Toward more reliable repair of ruptured sinus of Valsalva
Complete Atrioventricular Canal: Comparison of Modified Single-Patch Technique With Two-Patch Technique  Carl L. Backer, MD, Robert D. Stewart, MD, Frédérique.
Basal cusp enlargement for repair of aortic valve insufficiency
Huge aneurysms of the aortic sinuses of Valsalva with leaflet perforation in an infant: A case report  Atsushi Kawaguchi, MD, Kenji Waki, MD, Yoshio Arakaki,
Surgical Anatomy of the Aortic Annulus: Landmarks for External Annuloplasty in Aortic Valve Repair  Nizar Khelil, MD, Ghassan Sleilaty, MD, Michele Palladino,
A Novel Technique of Aortic Root Reconstruction for Extensive Endocarditis: The Pericardial Skirt Technique  Kiyoshi Doi, MD, PhD, Suguru Ohira, MD, Masahiro.
Remodeling the Aortic Root and Preservation of the Native Aortic Valve
New Technique of Aortic Root Reconstruction With Aortic Valve Annuloplasty in Ascending Aortic Aneurysm  Akhtar Rama, MD, Sylvain Rubin, MD, Nicolas Bonnet,
Successful aortic root remodeling for repair of a dilated pulmonary autograft after a ross- Konno procedure in early childhood  Shintaro Nemoto, MD, PhD,
Dennis M. Mello, MD, John Fahey, MD, Gary S. Kopf, MD 
G. Chad Hughes, MD, Madhav Swaminathan, MD, Walter G. Wolfe, MD 
Transposition of the Great Arteries and Quadricuspid Pulmonary Valve: An Unusual Combination  Marco Ricci, MD, Gordon A. Cohen, MD, PhD, Ergin Kocyildirim,
Aortic Valve Annuloplasty: New Single Suture Technique
Single Cusp Replacement for Aortic Regurgitation
Aortic Valve Reconstruction of Unicuspid Aortic Valve by Tricuspidization Using Autologous Pericardium  Isamu Kawase, MD, Shigeyuki Ozaki, MD, PhD, Hiromasa.
Valve-sparing root repair: V-shaped remodeling can be performed in all sinuses  Paul P. Urbanski, MD, PhD  The Journal of Thoracic and Cardiovascular Surgery 
Suspension String: A New Method of Aortic Valvuloplasty for Aortic Insufficiency and Ventricular Septal Defect  Zhixiong Huang, MD  The Annals of Thoracic.
Christopher J. Knott-Craig, MD, Steven P. Goldberg, MD, Edward D
Novel Technique of Valve-Sparing Aortic Root Replacement in Two Children Younger Than 3 Years of Age  James K. Kirklin, MD, Walter H. Johnson, MD, Barton.
Anatomy of the muscular subpulmonary infundibulum with regard to the Ross procedure  Anna F Merrick, Magdi H Yacoub, Siew Yen Ho, PhD, Robert H Anderson,
Concealed Left Ventricle to Right Atrium Fistula Complicating Infective Endocarditis  Tatsushi Onzuka, MD, PhD, Shoji Morishige, MD, Yoshiyuki Yamashita,
Ritu Sachdeva, MD, Richard T. Fiser, MD, William R
Chigozirim N. Ekeke, BS, Curt Daniels, MD, Subha V
Sinus Plication to Improve Valve Configuration in Bicuspid Aortic Valve Repair—Early Results  Ulrich Schneider, MD, Wolfram Schmied, Dipl-Psych, Diana.
Johannes M. Albes, MD, PhD, Ulrich A
Hans-H. Sievers, MD, Claudia Schmidtke, MD, MBA 
Bicuspidization of the Unicuspid Aortic Valve: A New Reconstructive Approach  Hans-Joachim Schäfers, MD, Diana Aicher, MD, Svetlana Riodionycheva, MD,
Dilatation of the Remaining Aorta After Aortic Valve or Aortic Root Replacement in Patients With Bicuspid Aortic Valve: A 5-Year Follow-Up  Nada Abdulkareem,
Aortic Valve-Sparing Procedure With Cusp Elongation and Free Edge Reinforcement for Bicuspid Aortic Valve  Francois Dagenais, MD, Richard Bauset, MD,
Patch Enlargement of the Aortic Annulus using the Manouguian Technique
Bartosz Rylski, MD, Joseph E. Bavaria, MD, Rita K
A novel method for reconstructing the sinus and annulus for the treatment of annuloaortic ectasia  Takeshi Shimamoto, MD, Akira Marui, MD, PhD, Takeshi.
Haiming Li, MD, Chengxiong Gu, MD  The Annals of Thoracic Surgery 
Selective Tricuspidization and Aortic Cusp Extension Valvuloplasty: Outcome Analysis in Infants and Children  Anastasios C. Polimenakos, MD, Shyam Sathanandam,
Valve-Sparing Aortic Root Replacement and Neochordal Repair of Complex Aortic Leaflet Pathology for Ruptured Sinus of Valsalva Aneurysm Fistulizing to.
Aortic Root Aneurysms: Remodeling or Composite Replacement?
The Neonatal Arterial Switch Operation: How I Teach It
Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function in Marfan Syndrome Patients  Seyed Hossein Aalaei-Andabili, MD, Tomas Martin, MD,
Andrew Gogbashian, MD, Ravi K
Fitsum Lakew, MD, Paul P. Urbanski, MD, PhD 
Tricuspid Valve Repair: How I Teach It
Root Stabilization of the Repaired Bicuspid Aortic Valve: Subcommissural Annuloplasty Versus Root Reimplantation  Prashanth Vallabhajosyula, MD, MS, Caroline.
Markus Liebrich, MD, Marcin K
David J. Kaczorowski, MD, Y. Joseph Woo, MD 
Perceval Sutureless Valve in Freestyle Root: New Surgical Valve-in-Valve Therapy  Emmanuel Villa, MD, PhD, Antonio Messina, MD, PhD, Marco Cirillo, MD,
Paul Urbanski, MD, PhD  The Annals of Thoracic Surgery 
Preservation of the Bicuspid Aortic Valve
New Aortic Root Remodeling Surgery in Aortic Root Aneurysm
The Florida Sleeve: A New Technique for Aortic Root Remodeling With Preservation of the Aortic Valve and Sinuses  Philip J. Hess, MD, Charles T. Klodell,
Long-Term Results of Aortomitral Fibrous Body Reconstruction With Double-Valve Replacement  Su Wan Kim, MD, Pyo Won Park, MD, PhD, Wook Sung Kim, MD,
Javariah Siddiqui, MBBS, Christian P. Brizard, MD, Igor E
Root Remodeling and Aortic Valve Repair for Unicuspid Aortic Valve
Late Outcomes for Surgical Repair of Supravalvar Aortic Stenosis
Marcelo G. Cardarelli, MD, James S. Gammie, MD, James M
Farirai F. Takawira, FCPaed(SA), Jayneel A. Joshi, FCPaed(SA), Dirk J
A new technique for aortic valve dysfunction: reconstruction by posterior leaflet of tricuspid valve  Hansong Sun, MD, Qiang Wang, MD, Shengshou Hu, MD,
Remodeling of the aortic root and reconstruction of the bicuspid aortic valve  Hans-Joachim Schäfers, MD, PhD, Frank Langer, MD, Diana Aicher, MD, Thomas.
Michael H. Hines, MD, Neal D. Kon, MD  The Annals of Thoracic Surgery 
Bicuspid Aortic Valves and Dilatation of the Ascending Aorta: Reply
Right ventricle-sparing heart transplant: promising new technique for recipients with pulmonary hypertension  John A Elefteriades, MD, Costantinos J Lovoulos,
Aortic Valve Sparing Root Replacement With Unroofing and Reconstruction of an Anomalous Right Coronary Artery  Giorgio Zanotti, MD, Rajan Gupta, MD, Thomas.
Pericardial Patch Augmentation for Reconstruction of Incompetent Bicuspid Aortic Valves  Mirko Doss, MD, Reinhard Moid, MD, Jeffrey Paul Wood, MD, Aleksandra.
Presentation transcript:

Results of Aortic Valve-Sparing and Restoration With Autologous Pericardial Leaflet Extensions in Congenital Heart Disease  Jonah Odim, MD, PhD, MBA, Hillel Laks, MD, Vivek Allada, MD, John Child, MD, Stacy Wilson, BS, David Gjertson, PhD  The Annals of Thoracic Surgery  Volume 80, Issue 2, Pages 647-654 (August 2005) DOI: 10.1016/j.athoracsur.2005.03.060 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Conversion of bicuspid aortic valve to tricuspid configuration and cusp augmentation with autologous pericardial leaflet extensions. The median raphe of the conjoined cusp is incised from the free edge up to the annulus. The fibrotic, stiff, and rolled-up free edges are thinned back to pliable tissue. Glutaraldehyde-treated autologous pericardial extensions are sewn to the native free-edges with a running polypropylene suture up to the aortic wall. The suture line is continued up the aortic wall (full thickness) to just below the sinotubular junction. The pericardial leaflet extensions are secured to one another over a pericardial pledget on the outside of the aorta. This creates neo-commissures just below the sinotubular junction (bold arrows at top) and a taller interleaflet triangle creating optimal zone of coaptation. The hinge point of the valve (arrows below) remains in the pliable native cusp remnant ensuring flexibility and valve function in the event of leaflet extension fibrosis or calcification. Dilated and aneurysmal sinuses of valsalva are excluded from the remodeled aortic root with glutaraldehyde-treated pericardial lining. It is typical for relative dilation of the noncoronary sinus; however with connective tissue disorders all three sinuses may be involved and are excluded with pericardial lining to prevent further dilation, rupture, or dissection. Sinuses harboring coronary arteries require pericardial button removal overlying the ostia. The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Fusion of noncoronary and right coronary cusps to form conjoined leaflet with doming of the bicuspid aortic valve (upper panel). Trileaflet valve conversion with autologous pericardial leaflet extensions with classic “Mercedes Benz” sign in cross-section and resolution of valve doming (lower panel). (ASC. AORTA = ascending aorta; LA = left atrium; LCA = left coronary artery; LV = left ventricle; RA = right atrium.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Freedom from valve-related reoperation. (AVR = aortic valve repair; CHD = congenital heart disease; post-OP = postoperative.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Freedom from valve-related reoperation after repair (age, < 19 years). (AVR = aortic valve repair; post-OP = postoperative.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Impact or restoration of trileaflet semilunar configuration. (AVR = aortic valve repair; post-OP = postoperative.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions