• Journal of Chest Surgery
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• v.37 no.10
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• pp.868-871
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• 2004

A 42 year old male was operated with aortic root abscess and pseudoaneurysm. Aortic valve vegetations which measured $8\times5$ cm and root abscess were removed and debrided. We reconstructed root and noncoronary sinus with autopericardium. Antibiotics were administered for 4 weeks. In general, Aortic root abscess recurs frequently and mortality is high. It is usually requires early surgical eradication with antibiotics medication.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.1009-1013
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• 1998

Bacterial endocarditis of the native aortic valve is associated with significant morbidity and mortality despite aggressive medical and surgical treatment, especially when perivalvular tissue was invaded and destructed. The pulmonary autograft is full viable and immune compatible tissue. This paper describes successful Ross operation as total root replacement in 38 years old native valve endocarditis patient with aortic root abscess.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.557-558
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• 2001

We operated on a Marfan patient who had Stanford type A acute aortic dissection, aortic root aneurysm, and aortic regurgitation. The Yacoub-David aortic root remodeling procedure which preserves native aortic valve and replaces all three aortic sinuses and ascending aorta by a Dacron graft, was applied for this patient. A 24mm Hemashield graft was designed to three tongues at the aortic root end to meet the shape of the Valsalva sinuses. The patient recovered from the procedure uneventfully and there was no aortic regurgitation posto-peratively.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1234-1237
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• 1998

Patients with aortic root disease, frequently seen in Marfan syndrome have progressive dilatation of the aortic sinuses and dilatation and distortion of the aortic annulus, leading to aortic incompetence. They are currently treated with composite graft replacement of the ascending aorta and aortic valve and reimplantation of the coronary arteries. Recently, we experienced an aortic root replacement with aortic valve preservation in a patient with annuloaortic ectasia. The ascending aorta and sinus was excised except the aortic annulus and aortic valve. The aortic valve was reimplanted inside of a collagen-impregnated tubular Dacron graft. The coronary arteries were also reimplanted. The patient was followed up for six months and reevaluated with the echocardiography. Postoperative Doppler echocardiography revealed normal aortic valve function. With this technique, it is possible to preserve the native aortic valve if the aortic leaflets are anatomically normal.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.308-311
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• 2010

Coarctation of the aorta is frequently associated with intracardiac disease. It is very difficult to decide on the best method for surgically treating adult patients with these combined heart diseases. We performed single-stage repair via a modified Bentall operation and by creating an intrapericardial ascending-descending aortic bypass through a median sternotomy in a patient with coarctation of the aorta and annuloaortic ectasia, and the latter was associated with aortic valve regurgitation.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.819-822
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• 1997

Aortic valve replacement with aortic allograft has been considered a treatment of choice for aortic valve disease secondary to bacterial endocarditis because of its good homodynamic performance and higher resistance to infection. The aortic root replacement technique might be superior to the subcoronary allograft implantation technique with regard to aortic regurgitation. A 46 yea,rs old male patient had acute aortic regurgitation with progressing heart failure secondary to acute bacterial endocarditis. The patient underwent emergent aortic root replacement using 20 mm aortic allograft. At operation, right coronary cusp perforation and heavy calcification of commissure between right and left coronary cusp were observed. The patient recovered well and postoperative echocardiography demonstrated no aortic regurgitation. Inflammatory signs were subsided after 8 weeks of antibiotics therapy. Medically uncontrolled acute bacterial endocarditis was treated successfully by aortic root replacement using aortic homograft.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.102-112
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• 2002

This study was undertaken to analyze the outcome of composite valve graftreplacement(CVGR) for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and June 2001, 56 patients had replacement of the ascending aorta and aortic root with a composite graft valve and were reviewed retrospectively. Aortic regurgitation was present in 50 patients(89%), Marfan's syndrome in 18 patients(32%), and bicuspid aortic valve in 7(12.5%). The indications for operation were annuloaortic ectasia(AAE) in 30 patients(53.6%), aortic dissection in 13(23.2%), aneurysms of the ascending aorta involving aortic root in 11(19.6%), and aortitis in 2(3.6%). Cardiogenic shock due to the aortic rupture was present in 2 patients. Nine patients(16%) had previous operations on the ascending aorta or open heart surgery. The operative techniques used for CVGR were the aortic button technique in 51 patients(91%), the modified Cabrol technique in 4, and the classic Bentall technique in 1. The concomitant procedures were aortic arch replacement in 24 patients(43%), coronary artery bypass graft in 8(14.3%), mitral valve repair in 2, redo mitral valve replacement in 1, and the others in 7 The mean time of circulatory arrest, total bypass, and aortic crossclamp were 21$\pm$14 minutes, 186$\pm$68 minutes, and 132$\pm$42 minutes, respectively. Result: Early mortality was 1.8%(1/56). The postoperative complications were left ventricular dysfunction in 16 patients(28.6%), reoperation for bleeding in 7(12.5%), pericardial effusion in 2, and the others in 7. Fifty-three patients out of 55 hospital survivors were followed up for a mean of 23.2 $\pm$ 18.7 months(1-75 months). There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage, and CVGR-related late mortality was 1.9%. The 1- and 6-year actuarial survival was 98.1$\pm$1.9% and 93.2$\pm$5.1%, respectively. Two patients required reoperation for complication of CYGR(3.8%) and two other patients required subsequent operations for dissection of the remaining thoracoabdominal aorta. The 1- and 6-year actuarial freedom from reoperation was 97.8$\pm$2.0% and 65.3$\pm$26.7%, respectively.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.260-265
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• 2010

Background: A composite valve graft replacement has been used for a variety of aortic root diseases. The aim of this study was to evaluate the mid-term results of this technique. Material and Method: We conducted a retrospective analysis of aortic root composite valve graft replacements in 39 patients and these procedures were done at our institution between 1992 and 2009. The mean age of the patients was $49.2{\pm}16.4$ years. The mean follow-up was $64.2{\pm}53.4$ months (maximum: 176 months). Result: There were 4 hospital deaths (8.6%) due to emergency aortic dissection and 4 late deaths owing to several causes. The causes of late death were 2 ruptures of a remnant aneurysm, 1 subdural hemorrhage and 1 paravalvular leakage. The calculated survival rate was 93.5%, 85.0% and 85.0% at 1, 5 and 10 years, respectively. There were 3 cerebrovascular accidents during the follow up period. The rate of freedom from cerebrovascular accidents was 97.0%, 92.0% and 80.0% at 1, 5 and 10 years, respectively. All of these brain accidents were hemorrhage-related complications. Conclusion: A composite valve graft replacement of the aortic root was associated with favorable results. So, this technique seems to be a good method to treat various aortic root diseases.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.356-364
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• 2002

Background: This study was undertaken to investigate the outcome of composite graft aortic root replacement using coronary button reimplantation technique for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and September 2001, 54 patients having aortic root replacement with a composite valve graft using direct coronary button reimplantation were reviewed retrospectively. Left ventricular dysfunction was present in 14 patients(25.9%), aortic regurgitation in 48(89%), and Marfan's syndrome in 17(31.5%). The indications for operation were annuloaortic ectasia in 29 patients(53.7%), aortic dissection in 11(20.4%), aneurysms of the ascending aorta involving aortic root in 12(22.2%), and aortitis in 2(3.7%). Six patients(11.1%) had previous cardiac or ascending aortic operations. Concomitant procedures were arch replacement in 21 patients(38.9%), coronary artery bypass graft in 7(13%), mitral valve repair or replacement in 4(7.4%), and others in 6. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 18 $\pm$ 9 minutes, 177 $\pm$ 42 minutes, and 127 $\pm$ 31 minutes, respectively. Result: There was 1 early death(1.9%). Mean follow-up was 24.6$\pm$ 19.5 months. There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage. The Kaplan-Meier survival rate was 98.0 $\pm$ 2.0% and 93.1 $\pm$ 5.1% at 1 and 6 years, respectively. Two patients required reoperation owing to a false aneurysm at the root anastomosis site and a malfunction of prosthetic aortic valve(3.8%). Staged operation for dissection of the remaining thoracoabdominal aorta was performed in 1 patient. The freedom rate from reoperation was 97.8 $\pm$ 2.0% and 65.3 $\pm$ 26.7% at 1 and 6 years, respectively.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.274-282
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• 2002

Background: Paravalvular leakage or false aneurysm developed after isolated aortic valve replacement(AVR) for aortic regurgitation(AR) associated with Behcet's disease is one of the most serious complications, and requires subsequent reoperations. We describe the surgical result of homograft aortic root replacement(ARR) for AR associated with Behcet's disease. Material and Method: From January 1992 to December 2001, 6 patients with AR associated with Behcet's disease underwent 7 ARR with homograft and 1 Ross operation. Five patients were male and one was female. The grafts used for ARR were 5 aortic and 2 pulmonic homografts. Ages at operation ranged from 27 to 51 years(mean, 37$\pm$9 years). Two patients underwent ARR with aortic homograft at the first operation. In the remaining 4 patients, ARR using a homograft was performed for paravalvular leakage that developed after AVR, and the mean interval from AVR to ARR was 21 $\pm$29 months(range, 5 to 73.3 moths, median, 7.6 months). Result: There was no early death. All patients were followed up for an average of 18.9$\pm$24.0 months(range, 1.9 to 68.9 months, median, 8.4 months). Two of 4patients who had undergone ARR after AVR required subsequent reoperations for false aneurysm of the ascending aorta and failure of pulmonary homograft. One patient underwent re-replacement of the aortic root, ascending aorta and partial aortic arch with an aortic homograft, the other underwent Ross operation. Conclusion: This study suggests that aortic root replacement using a homograft in aortic regurgitation with Behcet's disease may provide good clinical results and decrease the incidence of paravalvular leakage or false aneurysm after aortic valve replacement. However, the adequate perioperative management and complete removal of the inflarrunatory tissue at operation were also important for the good long-term results.