Integrating resuspension with remodeling: early results with a new valve-sparing aortic root reconstruction technique.
OBJECTIVE
Currently, two different valve-sparing aortic root reconstruction methods are utilized, namely reimplantation and remodeling. Herein are reported the authors' early results with a new technique that integrates the two procedures.


METHODS
Seven patients (age range: 25-69 years) underwent valve-sparing aortic root replacement with a new technique that integrates the principles of the David and Yacoub operations. The preoperative aortic root sizes were 4.9 to 7.0 cm, and six patients had aortic regurgitation (grade 1+ to 3+). Surgery was divisible into four stages: (i) External subcommissural (downsizing) annuloplasty; (ii) graft sizing and valve competency assessment with saline squirt test; (iii) sewing the individual tongues of a hand-scalloped Hemashield graft to the annular tissue with subvalvular pledgeted mattress sutures; and (iv) running suture lines to the commissural aspects of the aortic wall, followed by coronary reimplantation.


RESULTS
All patients survived surgery. Intraoperative transesophageal echocardiography showed trace aortic incompetence (AR) in five patients, and mild or moderate AR each in one patient. Over a two-year period the technique was improved to the above-described, four-stage approach, which resulted in only trace AR in the final three patients. Early serial transthoracic echocardiography confirmed stable root dimensions and no progression of AR, except in an early patient.


CONCLUSIONS
In the described technique, graft sizing is strictly tied to early intraoperative valve competency testing after an initial reconstruction within the native aortic root. The operation is then converted into a modified remodeling by suturing the triple-tongued (Yacoub) graft to the true aortic annulus with subannular pledgets (David principle). The operation involves significantly less dissection around the aortic root, and the entire scalloped annulus is stabilized in between the graft material and pledgets.
Kollar
Andras C
AC
Department of Surgery, The University of Texas Medical Branch, Galveston, Texas 77555-0528, USA. andraskollar@hotmail.com
Lick
Scott D
SD
Conti
Vincent R
VR
D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*