Partial aortic root remodeling
with selective replacement of the non-coronary sinus:
does aortic valve morphology influence outcomes?
Botta L, Cannata A, Bruschi G, Trunfio S, Merlanti B, Russo CF, Taglieri C, Martinelli L.
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
These aneurysms begin in the ascending aorta and extend into the root and
arch. The pattern of root dilation is determined by pressure and flow
characteristics. The sinotubular junction (STJ) enlarges first followed by the
noncoronary and right coronary sinuses. Though the annulus remains stable,
the respective valve cusps are retracted and splayed producing central aortic
regurgitation. The left coronary sinus usually retains normal dimensions until a
very advanced stage, except in patients with sitis inversus where the left sinus
dilates first.
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus
Replacement
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus
Replacement
MATERIALS and METHODS
APRIL 2003- OCTOBER 2009
29 PATIENTS
Tricuspid valve:
16 Pts (13 Males, Mean Age 65 ± 11
y)
Bicuspid valve:
13 Pts (11 Males, Mean Age 52 ± 12
y)
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus
Replacement
Pre-operative Features
13 pts
16 pts
Asc Ao and NC Sinus Rep
ETIOLOGY
AORTIC ROOT ANEURYSM
RUPTURED ANEURYSM
ACUTE TYPE A DISSECTION
PSEUDOANEURYSM
Mean Aortic Diameter 52.7 mm
REDO 3 pts
Asc Ao and NC Sinus Rep
ETIOLOGY
13 pts
0 pts
0 pts
0 pts
AORTIC ROOT ANEURYSM
RUPTURED ANEURYSM
ACUTE TYPE A DISSECTION
PSEUDOANEURYSM
14 pts
1 pt
0 pts
1 pts
Mean Aortic Diameter 52.2 mm
REDO 4 pts
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus
Replacement
Intra-operative Data
13 pts
Asc Ao and NC Sinus Rep
16 pts
Asc Ao and NC Sinus Rep
ASSOCIATED PROCEDURES
AVR
7 pts
LEAFLET PLASTY
3 pts
PROSTHETIC SUTURE 0 pts
ASSOCIATED PROCEDURES
AVR
5 pts
LEAFLET PLASTY
2 pts
PROSTHETIC SUTURE 2 pts
- CPB time:
- Cross Clamp Time
- CPB time:
- Cross Clamp Time
147 + 60 min
118 + 53 min
136 + 44 min
104 + 37 min
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus
Replacement
IN-HOSPITAL OUTCOMES
Post-Operative stay: 7 Days (median)
30 days MORTALITY: 0 pts
30 days MORBIDITY
- Stroke 1pt
- Renal/Respiratory Failure 1pt
30 days MORBIDITY
- Ventricular Fibrillation 1 pt
- Peripheral embolism 1 pt
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
Ascending Aorta and Isolated Non-Coronary Sinus
Replacement
FOLLOW-UP
100% completed
Mean: 32.3 months
Mean: 27.3 months
LATE MORTALITY: 0 pts
LATE MORBIDITY: 0 pts
AORTIC DISSECTION: 0 pts
RE-OPERATIONS: 0 pts
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
CONCLUSIONS
When dilatation of the aortic root is confined to the
Non-coronary sinus of Valsalva, the selective replacement
of this sinus may represent a good compromise, with
excellent early and midterm outcomes.
In patients with a bicuspid aortic valve, risk of aortic
related adverse events is rare and similar to that of
patients with a tricuspid valve.
More patients and a longer follow-up is mandatory to
confirm these preliminary results.
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy
THANK YOU FOR YOUR ATTENTION
Luca Botta MD, Cardiac Surgery Unit
Niguarda Cà Granda Hospital, Milan, Italy