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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Outcomes of different aortic arch replacement techniques.

Djamila Abjigitova1, Mostafa M Mokhles1, Grigorios Papageorgiou1,2

  • 1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

Journal of Cardiac Surgery
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Summary

The en bloc and separate graft techniques for aortic arch replacement show similar outcomes in mortality, survival, and reintervention rates. Both surgical approaches are effective for treating aortic arch pathology.

Keywords:
aortic archaortic surgeryarch repairarch replacement

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Treatment for aortic arch pathology lacks consensus due to diverse emerging procedures.
  • Open aortic arch replacement is a critical intervention for complex aortic conditions.

Purpose of the Study:

  • To compare outcomes of en bloc versus branched graft techniques for open aortic arch replacement.
  • To identify risk factors for adverse events in aortic arch surgery.

Main Methods:

  • Retrospective analysis of 172 patients undergoing open aortic arch replacement between 1974 and 2017.
  • Comparison between en bloc (island) graft technique (n=59) and separate branched graft technique (n=113).
  • Analysis of emergent/urgent treatment settings (52.4% of patients).

Main Results:

  • En bloc technique demonstrated significantly shorter cardiopulmonary bypass and aortic cross-clamp times.
  • Hospital mortality was lower in the en bloc group (8.5% vs. 19.5%), though not statistically significant.
  • No significant differences in survival rates at 1, 5, or 10 years, nor in postoperative stroke rates between the two techniques.
  • Diabetes and elephant trunk procedures were identified as risk factors for reintervention.

Conclusions:

  • The separate graft technique, currently more prevalent, showed comparable hospital mortality and morbidity to the en bloc technique.
  • Late survival and reintervention rates were similar for both en bloc and separate graft aortic arch replacement procedures.
  • Both techniques are viable options for aortic arch pathology, with specific patient factors influencing reintervention risk.