Johannes M. Albes, MD, PhD, Ulrich A

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Presentation transcript:

Restitution of the Aortic Valve: What is New, What is Proven, and What is Obsolete? Johannes M. Albes, MD, PhD, Ulrich A. Stock, MD, PhD, Martin Hartrumpf, MD The Annals of Thoracic Surgery Volume 80, Issue 4, Pages 1540-1549 (October 2005) DOI: 10.1016/j.athoracsur.2005.02.010 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Freedom from reoperation. Cumulative actuarial freedom from reoperation and cumulative patients at risk of all three investigated methods of reimplantation (diamonds), remodeling (boxes) and resuspension (triangles). Data are extrapolated from 31 studies. The Annals of Thoracic Surgery 2005 80, 1540-1549DOI: (10.1016/j.athoracsur.2005.02.010) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Correlation between sample size and 5-year freedom from reoperation; observed (boxes) and linearized (dashed line). Pearson product-moment correlation coefficient obtained from 31 studies. The Annals of Thoracic Surgery 2005 80, 1540-1549DOI: (10.1016/j.athoracsur.2005.02.010) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Remodeling technique: computerized rendering of an aortic root (translucent view) prepared for a remodeling or reimplantation maneuver. (a) All sinuses including the coronary ostia are excised yielding a “quasi-stentless” valve, whereas the basis remains in place. The prosthesis is fashioned with three tongues that are attached to the sinus edges with non-absorbable 5-0 or 4-0 polypropylene running sutures. (b) Both previously excised coronary ostia are anastomosed to the prosthesis at the appropriate level within the “neo-sinus” (4-0 or 5-0 polypropylene). The Annals of Thoracic Surgery 2005 80, 1540-1549DOI: (10.1016/j.athoracsur.2005.02.010) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Resuspension technique: (a, b) U-shaped (4-0 polypropylene) sutures are passed through the aortic wall at the level of the commissures from inside to outside, passed through the edge of an appropriately sized prosthesis in an isosceles fashion, knotted, and used as running sutures to complete the anastomosis. (c) In addition, a reinforcement plasty of an isolated enlarged annulus can be performed. The diameter is reduced by means of a Hegar obturator of appropriate diameter (typically 24 to 28 mm) passed through the native annulus while the Teflon-strip (DuPont, Wilmington, DE) reinforced mattress suture (4-0 polypropylene) is tightened around the stick. Alternatively U-shape sutures and a Teflon strip of defined length can be used. The Annals of Thoracic Surgery 2005 80, 1540-1549DOI: (10.1016/j.athoracsur.2005.02.010) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Reimplantation technique: (a) a tubular graft is placed upon the prepared root. (b) U-shaped, non-absorbable 3-0 polypropylene sutures are placed in a transannular fashion from inside to outside while forming a horizontal plane just below the native annulus. Optionally, these sutures can be reinforced with Teflon-pledgets (DuPont, Wilmington, DE). The prosthesis is thereafter connected with these sutures. (c) The commissures are positioned inside the prosthesis ensuring proper height and alignment. Thereafter the sinus edges are anastomosed to the prosthesis wall with 5-0 or 4-0 non-absorbable polypropylene running sutures. Reimplantation of both coronary ostia is then performed. The Annals of Thoracic Surgery 2005 80, 1540-1549DOI: (10.1016/j.athoracsur.2005.02.010) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions