Clinical effectiveness of valve-sparing aortic root replacement in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xi , TAN Jin , HUANG Keli , YU Tao ,  JIANG Lu

Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, P. R. China;

Corresponding author：

JIANG Lu, Email: jll1230515@163.com

Keywords：

Valve-sparing aortic root replacement; tetralogy of Fallot; aortic root dilatation

DOI：

10.7507/1007-4848.202306044

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.

Citation： LI Xi, TAN Jin, HUANG Keli, YU Tao, JIANG Lu. Clinical effectiveness of valve-sparing aortic root replacement in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 122-126. doi: 10.7507/1007-4848.202306044 Copy

1.	David TE, Feindel CM, David CM, et al. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg, 2014, 148(3): 872-879.
2.	Vricella LA, Cameron DE. Valve-sparing aortic root replacement in pediatric patients: Lessons learned over two decades. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2017: 56-62.
3.	Patlolla SH, Saran N, Dearani JA, et al. Outcomes and risk factors of late failure of valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2022, 164(2): 493-501.
4.	Baliulis G, Ropponen JO, Salmon TP, et al. Valve-sparing aortic root replacement in adult patients previously operated for congenital heart defects: An initial experience. Eur J Cardiothorac Surg, 2016, 50(1): 155-159.
5.	Dearani JA, Burkhart HM, Stulak JM, et al. Management of the aortic root in adult patients with conotruncal anomalies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009: 122-129.
6.	Tan JL, Gatzoulis MA, Ho SY. Aortic root disease in tetralogy of Fallot. Curr Opin Cardiol, 2006, 21(6): 569-572.
7.	Nguyen HS, Nguyen HD, Tong PD, et al. Concomitant valve-sparing aortic root replacement with tetralogy of Fallot repair in a 30-year-old patient: A case report. Int J Surg Case Rep, 2021, 82: 105930.
8.	Adachi O, Suzuki T, Yoshioka I, et al. Concomitant valve-sparing aortic root replacement with repair of tetralogy of Fallot. Ann Thorac Surg, 2019, 108(2): e99-e101.
9.	Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: A new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750.
10.	Niwa K, Siu SC, Webb GD, et al. Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot. Circulation, 2002, 106(11): 1374-1378.
11.	Niwa K, Perloff JK, Bhuta SM, et al. Structural abnormalities of great arterial walls in congenital heart disease: Light and electron microscopic analyses. Circulation, 2001, 103(3): 393-400.
12.	Mazine A, Chu MWA, El-Hamamsy I, et al. Valve-sparing aortic root replacement: A primer for cardiologists. Curr Opin Cardiol, 2022, 37(2): 156-164.
13.	Perri JL, Chen EP. Valve-sparing root replacement-reimplantation technique. Ann Cardiothorac Surg, 2023, 12(3): 268-275.
14.	Eishi J, Miura T, Obase K, et al. Total root remodelling by the Sleeve technique for aortic regurgitation in patients with repaired tetralogy of Fallot. Eur J Cardiothorac Surg, 2019, 56(6): 1196-1198.
15.	Patel ND, Alejo D, Crawford T, et al. Aortic root replacement for children with Loeys-Dietz syndrome. Ann Thorac Surg, 2017, 103(5): 1513-1518.
16.	Patel ND, Arnaoutakis GJ, George TJ, et al. Valve-sparing aortic root replacement in Loeys-Dietz syndrome. Ann Thorac Surg, 2011, 92(2): 556-560.
17.	Fraser CD, Liu RH, Zhou X, et al. Valve-sparing aortic root replacement in children: Outcomes from 100 consecutive cases. J Thorac Cardiovasc Surg, 2019, 157(3): 1100-1109.
18.	Kari FA, Misfeld M, Borger M, et al. German aortic root repair registry-insights from the first 400 consecutive patients. Ann Thorac Surg, 2022, 113(2): 608-615.

1. David TE, Feindel CM, David CM, et al. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg, 2014, 148(3): 872-879.
2. Vricella LA, Cameron DE. Valve-sparing aortic root replacement in pediatric patients: Lessons learned over two decades. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2017: 56-62.
3. Patlolla SH, Saran N, Dearani JA, et al. Outcomes and risk factors of late failure of valve-sparing aortic root replacement. J Thorac Cardiovasc Surg, 2022, 164(2): 493-501.
4. Baliulis G, Ropponen JO, Salmon TP, et al. Valve-sparing aortic root replacement in adult patients previously operated for congenital heart defects: An initial experience. Eur J Cardiothorac Surg, 2016, 50(1): 155-159.
5. Dearani JA, Burkhart HM, Stulak JM, et al. Management of the aortic root in adult patients with conotruncal anomalies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009: 122-129.
6. Tan JL, Gatzoulis MA, Ho SY. Aortic root disease in tetralogy of Fallot. Curr Opin Cardiol, 2006, 21(6): 569-572.
7. Nguyen HS, Nguyen HD, Tong PD, et al. Concomitant valve-sparing aortic root replacement with tetralogy of Fallot repair in a 30-year-old patient: A case report. Int J Surg Case Rep, 2021, 82: 105930.
8. Adachi O, Suzuki T, Yoshioka I, et al. Concomitant valve-sparing aortic root replacement with repair of tetralogy of Fallot. Ann Thorac Surg, 2019, 108(2): e99-e101.
9. Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: A new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750.
10. Niwa K, Siu SC, Webb GD, et al. Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot. Circulation, 2002, 106(11): 1374-1378.
11. Niwa K, Perloff JK, Bhuta SM, et al. Structural abnormalities of great arterial walls in congenital heart disease: Light and electron microscopic analyses. Circulation, 2001, 103(3): 393-400.
12. Mazine A, Chu MWA, El-Hamamsy I, et al. Valve-sparing aortic root replacement: A primer for cardiologists. Curr Opin Cardiol, 2022, 37(2): 156-164.
13. Perri JL, Chen EP. Valve-sparing root replacement-reimplantation technique. Ann Cardiothorac Surg, 2023, 12(3): 268-275.
14. Eishi J, Miura T, Obase K, et al. Total root remodelling by the Sleeve technique for aortic regurgitation in patients with repaired tetralogy of Fallot. Eur J Cardiothorac Surg, 2019, 56(6): 1196-1198.
15. Patel ND, Alejo D, Crawford T, et al. Aortic root replacement for children with Loeys-Dietz syndrome. Ann Thorac Surg, 2017, 103(5): 1513-1518.
16. Patel ND, Arnaoutakis GJ, George TJ, et al. Valve-sparing aortic root replacement in Loeys-Dietz syndrome. Ann Thorac Surg, 2011, 92(2): 556-560.
17. Fraser CD, Liu RH, Zhou X, et al. Valve-sparing aortic root replacement in children: Outcomes from 100 consecutive cases. J Thorac Cardiovasc Surg, 2019, 157(3): 1100-1109.
18. Kari FA, Misfeld M, Borger M, et al. German aortic root repair registry-insights from the first 400 consecutive patients. Ann Thorac Surg, 2022, 113(2): 608-615.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effectiveness of valve-sparing aortic root replacement in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot

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