FATE OF AORTIC VALVE IN SURGICAL MANAGEMENT OF TYPE A AORTIC DISSECTION
MINA SAMEH AIAD WAHBA;
Abstract
Type A aortic dissection according to the Stanford classification
involves, per definition, the ascending aorta. But in many cases the
mechanism of aortic regurgitation is secondary to a root disease. In the case
of dissection associated with root aneurysm, the dilatation of the
sinotubular junction is responsible for the loss of central coaptation of the
aortic leaflets. In the case of acute aortic dissection, the valve insufficiency
is due to the loss of wall support causing cusp prolapse. In such clinical
settings, the valve is anatomically normal.
The composite graft replacement of the aortic valve and root
(modified Bentall procedure) has been the standard method to surgically
correct concomitant aortic insufficiency and root aneurysm or dissection.
Such operation should be limited to certain situations 1- irrepairable and
unhealthy aortic valve leaflets (calcific - rheumatic). 2- in patients who
have aortic annulus dilatation (>27mm) because these patients have a
greater propensity to develop root aneurysm late after surgery for many
years.
However, the modified Bentall procedure also exposes the patient to
many risks associated with artificial valves. Mechanical valves, while long
lasting, require life-long anticoagulation and increase incidence of prothetic
infective endocaditis biological valves, while not requiring anticoagulation,
expose the patient to the potential need for reoperation in 8–12 years which
should be limited to elder patients, in the case of a re-do modified Bentall,
is a major and relatively risky operation.
Operations that replace the aortic root while preserving the valve
have been developed by pioneers as Magdi Yacoub (remodelling procedure
used since 1979) and Tirone David (reimplantation procedure performed
since 1988) in an effort to improve quality of life for many patients. The
native aortic valve should be preserved whenever possible because a
perfect prosthetic aortic valve is yet to be developed. The principal
determinant of successful aortic valves sparing operations is the quality of
the aortic valve leaflets and surgeon experience in this surgical technique.
At last supracoronary conduit are considered as appropriate option to
involves, per definition, the ascending aorta. But in many cases the
mechanism of aortic regurgitation is secondary to a root disease. In the case
of dissection associated with root aneurysm, the dilatation of the
sinotubular junction is responsible for the loss of central coaptation of the
aortic leaflets. In the case of acute aortic dissection, the valve insufficiency
is due to the loss of wall support causing cusp prolapse. In such clinical
settings, the valve is anatomically normal.
The composite graft replacement of the aortic valve and root
(modified Bentall procedure) has been the standard method to surgically
correct concomitant aortic insufficiency and root aneurysm or dissection.
Such operation should be limited to certain situations 1- irrepairable and
unhealthy aortic valve leaflets (calcific - rheumatic). 2- in patients who
have aortic annulus dilatation (>27mm) because these patients have a
greater propensity to develop root aneurysm late after surgery for many
years.
However, the modified Bentall procedure also exposes the patient to
many risks associated with artificial valves. Mechanical valves, while long
lasting, require life-long anticoagulation and increase incidence of prothetic
infective endocaditis biological valves, while not requiring anticoagulation,
expose the patient to the potential need for reoperation in 8–12 years which
should be limited to elder patients, in the case of a re-do modified Bentall,
is a major and relatively risky operation.
Operations that replace the aortic root while preserving the valve
have been developed by pioneers as Magdi Yacoub (remodelling procedure
used since 1979) and Tirone David (reimplantation procedure performed
since 1988) in an effort to improve quality of life for many patients. The
native aortic valve should be preserved whenever possible because a
perfect prosthetic aortic valve is yet to be developed. The principal
determinant of successful aortic valves sparing operations is the quality of
the aortic valve leaflets and surgeon experience in this surgical technique.
At last supracoronary conduit are considered as appropriate option to
Other data
| Title | FATE OF AORTIC VALVE IN SURGICAL MANAGEMENT OF TYPE A AORTIC DISSECTION | Authors | MINA SAMEH AIAD WAHBA | Issue Date | 2014 |
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