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Allan Stewart, MD. , Jonathan A. Yang, MD; Mark J

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Presentation on theme: "Allan Stewart, MD. , Jonathan A. Yang, MD; Mark J"— Presentation transcript:

1 Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall
Allan Stewart, MD., Jonathan A. Yang, MD; Mark J. Russo, MD/MPH; Alexander Iribarne, MD; Brendan F. Scully; Rachel Easterwood; Craig R. Smith, MD; Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY

2 Aortic Insufficiency & Root Aneurysm
Different treatment options exist Bentall Procedure1 Several modifications Valve-sparing root replacement (VSRR) Sir Magdi Yacoub, Tirone David We have performed both at our Institution since 2005 1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 23(4):338-9.

3 Methods Retrospective study Peri-Operative and short-term data
VSRR via the re-implantation method described by David, et al1 Modified Bentall Procedures – novel composite biologic graft 1. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg April; 103(4):

4 Valve-Sparing Root Replacement

5 Edwards Perimount Valve
BioRoot Edwards Perimount Valve ATS 3f Valve

6 BioRoot

7 Results 150.845.6 153.755.5 112.433.4 108.934.8 Valve-Sparing
Root Replacement BioRoot p Number of patients 111 175 - Mean Age in years (Range) 55 63 <0.0001 Pre-Op AI 2+ 75 (67.6%) 145 (82.6%) 0.0044 Mean Cardiopulmonary Bypass Time (min) 150.845.6 153.755.5 0.6 Mean Aortic Cross-Clamp Time (min) 112.433.4 108.934.8 0.4 Post-Op AI 2+ 0% Need for Re-op for AVR 2 (1.8%) 0 (0%) 30-day Mortality 1 (0.9%) 2 (1.1%) 0.8

8 Pre-Treatment Decisions
Replace Severe Annular Dilatation (>32mm) Severe Leaflet Damage Repair Normal Leaflets Isolated Pathology Young Patient

9 “Real-time” Repair Algorithm (AI + Aneurysm)
Reimplantation Can valve be Repaired? Should it be Repaired? Repair Yes Yes Remodeling No BioRoot Should it be Replaced? Yes Replace Mechanical Conduit No Ignore

10 When Should We Repair? Aortic Leaflet Integrity
Reliable valve-sparing results with: supple leaflets normal annular size Bicuspid and tri-leaflets have good 10-year data High Failure Rates with: Severe AI Multi-leaflet Prolapse Multiple Fenestrations

11 When Should We Replace? Marked leaflet Asymmetry
Multiple leaflet Fenestrations “Broken leaflets” Bicuspid Patients Significant Thickening Prolapse Calcification Multiple Fenestrations Connective Tissue Patients Data is unclear Be cautious in repairing attenuated & severely prolapsed valves

12 Conclusions Similar operative times
Low rates of post-op AI, repeat AVR and mortality Similar short-term outcomes Reproducible and safe Need to delineate proper guidelines for indications Follow-up needed to assess long-term outcomes

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