The Journal of thoracic and cardiovascular surgery
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Root remodeling was proposed as valve-preserving root replacement to treat patients with aortic regurgitation and root aneurysm. The objective of this retrospective study was to review 18 years of experience with root remodeling and to identify predictors of valve durability. ⋯ Root remodeling continues to be a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve geometry, reproducible restoration of aortic valve function can be achieved with good long term durability.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
ReviewTrifurcated graft replacement of the aortic arch: state of the art.
To review the contemporary practice in total arch replacement (TAR) by using the trifurcated graft technique. ⋯ The trifurcated graft technique is a versatile method in TAR that can be applied to a diverse range of aortic anatomies, pathologies and hybrid arch procedures, with concomitant or staged endovascular options. UACP or BACP and lower body ischemia can be performed without adding significant complexity to the procedure, while conferring maximal cerebral, spinal, and lower body protection.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
ReviewUse of genetics for personalized management of heritable thoracic aortic disease: how do we get there?
The major diseases affecting the thoracic aorta are aortic aneurysms and acute aortic dissections. Medical treatments can slow the enlargement of aneurysms, but the mainstay of treatment to prevent premature death resulting from dissection is surgical repair of the thoracic aortic aneurysm, which is typically recommended when the aortic diameter reaches 5.0 to 5.5 cm. ⋯ Data from genetic studies during the past decade have established that mutations in specific genes can distinguish patients at risk for the disease and predict the risk of early dissection at diameters smaller than 5.0 cm. This information has the potential to optimize the timing of aortic surgery to prevent acute dissections.
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Congenital diseases of the aorta tend to be obstructive when they present early in life, and aneurysmal when they present later in life. The latter group also tends to be associated with connective tissue disorders and with repaired conotruncal lesions. ⋯ Disorders such as Loeys-Dietz syndrome and Turner syndrome may deserve aggressive prophylactic surgery, as well as Marfan syndrome to a lesser extent. The natural history of the dilated aorta after repair of congenital heart lesions is probably more benign than de novo aneurysms and therefore should be treated conservatively.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Comparative StudyValve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: comparison with the 3-cusp David procedure.
Valve-sparing root reimplantation (VSRR) in tricuspid aortic valve (TAV) patients is well established, but in bicuspid aortic valve (BAV) patients, it has been less widely adopted. We assessed whether valve type affects midterm outcomes with VSRR. ⋯ Even though BAV patients present with higher AI grade and require concomitant primary valve repair, the VSRR David V technique offers excellent midterm outcomes with both the BAV and TAV valve types.