Evolution Over Time of Aortic Root Anatomy after Aortic Valve Reimplantation
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0128
Submission Type:
Abstract Submission
Authors:
Francesco Giosuè Irace (1), Giulio Folino (2), Ilaria Chirichilli (1), Andrea Salica (2), Raffaele Scaffa (2), Luca Paolo Weltert (2), Ruggero De Paulis (2)
Institutions:
(1) Department of Cardiac Surgery, Ospedale San Camillo-Forlanini, Rome, Italy, (2) Department of Cardiac Surgery, European Hospital, Rome, Italy
Submitting Author:
Francesco Giosuè Irace
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Department of Cardiac Surgery, Ospedale San Camillo-Forlanini
Department of Cardiac Surgery, Ospedale San Camillo-Forlanini
Co-Author(s):
Giulio Folino
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Department of Cardiac Surgery, European Hospital
Department of Cardiac Surgery, European Hospital
Ilaria Chirichilli
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Department of Cardiac Surgery, Ospedale San Camillo-Forlanini
Department of Cardiac Surgery, Ospedale San Camillo-Forlanini
Andrea Salica
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Department of Cardiac Surgery, European Hospital
Department of Cardiac Surgery, European Hospital
Raffaele Scaffa
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Department of Cardiac Surgery, European Hospital
Department of Cardiac Surgery, European Hospital
Luca Paolo Weltert
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Department of Cardiac Surgery, European Hospital
Department of Cardiac Surgery, European Hospital
*Ruggero De Paulis
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Department of Cardiac Surgery, European Hospital
Department of Cardiac Surgery, European Hospital
Presenting Author:
Francesco Giosuè Irace
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Abstract:
Objective: Recent studies have analysed the anatomical relationships between the aortic root components (sino-tubular junction, ventricular-arterial junction and virtual basal ring), to improve results of root reconstruction and valve competence over time. In a previous work from our group, we analysed the in vivo anatomy of the aortic root after a with the Valsalva graft. The aim of this study is to evaluate the in vivo evolution over time of the anatomical features after reimplantation procedure with sinuses reconstruction
Methods: Ten patients with tricuspid aortic valve underwent a reimplantation procedure with Valsalva graft, between March 2019 and April 2020. At the time of procedure, surgical haemoclips were applied at the level of proximal annular knots and at the distal reimplanted commissures on the neo-sinutubular junction, as radiopaque markers. All patients underwent an ECG-gated heart CT scan before discharge and at follow-up. Images were reconstructed with 3D software and aortic root features were measured in both series and compared. We analyzed the annular dimensions and the distance between annular knots haemoclip and virtual basal ring, both as height from the annular plane and as distance (thickness) from the annular lumen.
Results: The mean follow-up time was 50 ± 4 months. There were no deaths, nor reoperation or recurrence of moderate-to-severe aortic regurgitation. We found no significant differences in annular dimensions after 4 years. Post-operative measures vs. follow-up measures were: mean major diameter 25.3 ± 1.1 vs. 27.6 ± 0.9 mm (p: 0.024), mean minor diameter 22.9 ± 0.9 vs. 23.6 ± 0.5 mm (p: 0.09), mean perimeter 77.9 ± 2.5 vs. 80.7 ± 2.3 mm (p: 0.05), mean area 478.6 ± 38.9 vs. 504.3 ± 22.2 mm2 (p: 0.15), mean ellipticity index (major diameter / minor diameter) 1.10 ± 0.04 vs. 1.13 ± 0.04 (p: 0.23). The mean heights of Dacron graft basal landmarks from virtual basal ring were also not significantly modified form post-operative values to follow-up's: Right-Left commissure 6.6 ± 2.0 vs. 5.2 ± 1.1 mm (p: 0.16); Right sinus 6.1 ± 1.9 vs. 5.6 ± 1.3 mm (p: 0.53); Right-Non Coronary commissure 6.1 ± 1.6 vs. 5.3 ± 2.1 mm (p: 0.45); Non Coronary sinus 2.1 ± 1.7 vs. 2.1 ± 1.2 mm (p: 1); Left-Non Coronary commissure 2.4 ± 1.5 vs. 1.3 ± 0.9 mm (p: 0.11); Left sinus 2.7 ± 1.4 vs. 1.8 ± 1.1 mm (p: 0.22). The mean planar distances of basal Dacron graft landmarks from virtual basal ring (thickness) were: Right-Left commissure 5.1 ± 1.3 vs. 4.6 ± 1.3 mm (p:0.43); Right sinus 4.9 ± 1.6 vs. 5.1 ± 1.3 mm (p: 0.72); Right-Non Coronary commissure 3.7 ± 0.5 vs. 3.1 ± 1.1 mm (p: 0.22); Non Coronary sinus 4.0 ± 0.8 vs. 3.1 ± 0.7 mm (p: 0.05); Left-Non Coronary commissure 3.1 ± 0.7 vs. 2.8 ± 0.7 mm (p: 0.45); Left sinus 3.3 ± 1.1 vs. 3.4 ± 0.8 mm (p: 0.78).
Conclusions: After a 4-year mean follow up, no significant modification of the relationships in aortic root components occurred. The proximal edge of the Dacron graft lies at the ventricular-arterial junction at a slightly different thickness and height along the annular circumference, especially at the level of right sinus and left-right commissure. This feature persists at follow-up. Annular stabilization appears unaffected. A minimal, not significant, reduction of the tissue thickness all along the annulus and a minimal, not significant, increase in annular dimensions were noted.
Methods: Ten patients with tricuspid aortic valve underwent a reimplantation procedure with Valsalva graft, between March 2019 and April 2020. At the time of procedure, surgical haemoclips were applied at the level of proximal annular knots and at the distal reimplanted commissures on the neo-sinutubular junction, as radiopaque markers. All patients underwent an ECG-gated heart CT scan before discharge and at follow-up. Images were reconstructed with 3D software and aortic root features were measured in both series and compared. We analyzed the annular dimensions and the distance between annular knots haemoclip and virtual basal ring, both as height from the annular plane and as distance (thickness) from the annular lumen.
Results: The mean follow-up time was 50 ± 4 months. There were no deaths, nor reoperation or recurrence of moderate-to-severe aortic regurgitation. We found no significant differences in annular dimensions after 4 years. Post-operative measures vs. follow-up measures were: mean major diameter 25.3 ± 1.1 vs. 27.6 ± 0.9 mm (p: 0.024), mean minor diameter 22.9 ± 0.9 vs. 23.6 ± 0.5 mm (p: 0.09), mean perimeter 77.9 ± 2.5 vs. 80.7 ± 2.3 mm (p: 0.05), mean area 478.6 ± 38.9 vs. 504.3 ± 22.2 mm2 (p: 0.15), mean ellipticity index (major diameter / minor diameter) 1.10 ± 0.04 vs. 1.13 ± 0.04 (p: 0.23). The mean heights of Dacron graft basal landmarks from virtual basal ring were also not significantly modified form post-operative values to follow-up's: Right-Left commissure 6.6 ± 2.0 vs. 5.2 ± 1.1 mm (p: 0.16); Right sinus 6.1 ± 1.9 vs. 5.6 ± 1.3 mm (p: 0.53); Right-Non Coronary commissure 6.1 ± 1.6 vs. 5.3 ± 2.1 mm (p: 0.45); Non Coronary sinus 2.1 ± 1.7 vs. 2.1 ± 1.2 mm (p: 1); Left-Non Coronary commissure 2.4 ± 1.5 vs. 1.3 ± 0.9 mm (p: 0.11); Left sinus 2.7 ± 1.4 vs. 1.8 ± 1.1 mm (p: 0.22). The mean planar distances of basal Dacron graft landmarks from virtual basal ring (thickness) were: Right-Left commissure 5.1 ± 1.3 vs. 4.6 ± 1.3 mm (p:0.43); Right sinus 4.9 ± 1.6 vs. 5.1 ± 1.3 mm (p: 0.72); Right-Non Coronary commissure 3.7 ± 0.5 vs. 3.1 ± 1.1 mm (p: 0.22); Non Coronary sinus 4.0 ± 0.8 vs. 3.1 ± 0.7 mm (p: 0.05); Left-Non Coronary commissure 3.1 ± 0.7 vs. 2.8 ± 0.7 mm (p: 0.45); Left sinus 3.3 ± 1.1 vs. 3.4 ± 0.8 mm (p: 0.78).
Conclusions: After a 4-year mean follow up, no significant modification of the relationships in aortic root components occurred. The proximal edge of the Dacron graft lies at the ventricular-arterial junction at a slightly different thickness and height along the annular circumference, especially at the level of right sinus and left-right commissure. This feature persists at follow-up. Annular stabilization appears unaffected. A minimal, not significant, reduction of the tissue thickness all along the annulus and a minimal, not significant, increase in annular dimensions were noted.
Aortic Symposium:
Aortic Root
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