• Journal of Chest Surgery
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• v.33 no.4
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• pp.285-289
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• 2000

Background: For AVR using conventional prosthetic valves in adult patients with a narrow aortic root, aortic root enlargement is necessary to reduce postoperative pressure gradient across the aortic valve (ΔP). An evaluation of early and mid-term results of aortic root enlargement with AVR and echocardiographic follow up of ΔP and left ventricular function was performed. Method: From Aug. 1991 to Feb. 1998, eighteen patients aged 17 to 59 years(mean, 38$\pm$12 years) underwent Manouguian procedure with AVR. Aortic annular circumstance was enlarged 10.0mm to 18.0mm(mean, 12.6$\pm$6.3mm). Eight patients(44.0%) had NYHA class III status before operation, and seven cases of them underwent concomitant MVR. Valve pathology was ASr in 6 cases, AS in 4 cases, nd ASr+MSr in 8 cases. Replaced valve size was 21mm in 8 cases and 23 mm in 10 cases, and St. Jude Medical mechanical valve was used in 10 cases and Carbomedics in 8 cases. Result: Follow-up duration was 6 to 57 months (mean, 26$\pm$18 months), and total follow-up was 287 patient-year. There were one hospital death and one late death, therefore, actuarial survival rate was 85.7% at 56 months. Peak ΔP wad decreased significantly at postoperative mid-term period as 13$\pm$5mmHg, compared with thepreoperative one (42$\pm$8mmHg) (p<0.01). LVM(gm/$m^2$) was also diminished as 35.8%(115$\pm$36gm/$m^2$)at postoperative mid-term period, compared with preoperative one (179$\pm$56gm/$m^2$)(p<0.05). Conclusion: There were no specific complications related to the procedure. And we could have adequate enlargement of aortic annulus to suitable prosthetic valve that have no effect of patient-prosthese mismatch.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.188-198
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• 2002

Background: Reoperations on the aortic root or the ascending aorta are being performed with increasing frequency and remain a challenging problem. This study was performed to analyze the results of reoperations on the ascending aorta and aortic root. Material and Method: Between May 1995 and April 2001, 30 patients had reoperations on the ascending aorta and aortic root and were reviewed retrospectively. The mean interval between the previous repair and the actual reoperation was 56 months(range 3 to 142 months). Seven patients(23.3%) had two or more previous operations. The indications for reoperations were true aneurysm in 7 patients(23.3%), prosthetic valve endocarditis in 6(20%), false aneurysm in 5(16.7%), paravalvular leak associated with Behcet's disease in 4(13.3%), malfunction of prosthetic aortic valve in 4(13.3%), aortic dissection in 3(10%), and annuloaortic ectasia in 1(3.3%). The principal reoperations performed were aortic root replacement in 17 patients(56.7%), replacement of the ascending aorta in 8(26.7%), aortic and mitral valve replacement with reconstruction of fibrous trigone in 2(6.6%), patch aortoplasty in 2(6.6%), and aortic valve replacement after Bentall operation in 1 (3.3%). The cardiopulmonary bypass was started before sternotomy in 7 patients and the hypothermic circulatory arrest was used in 16(53.3%). The mean time of circulatory arrest, total bypass, and aortic crossclamp were 20$\pm$ 12 minutes, 228$\pm$56 minutes, and 143$\pm$62 minutes, respectively Result: There were three early deaths(10%). The postoperative complications were reoperation for bleeding in 7 patients(23.3%), cardiac complications in 5(16.7%), transient acute renal failure in 2(6.6%), transient focal seizure in 2(6.6%), and the others in 5. The mean follow-up was 22.8 $\pm$20.5 months. There were two late deaths(7.4%). The actuarial survival was 92.6$\pm$5.0% at 6 years. One patient required reoperation for complication of reoperation on the ascending aorta and aortic root(3.7%). The 1- and 6-year actuarial freedom from reoperation was 100% and 83.3$\pm$15.2%, respectively. One patient with Behcet's disease are waiting for reoperation due to false aneurysm, which developed after aortic root replacement with homograft. There were no thromboembolisms or anticoagulant related complications. Conclusions: This study suggests that reoperations on the ascending aorta and aortic root can be performed with acceptable early mortality and morbidity, and adequate surgical strategies according to the pathologi conditions are critical to the prevention of the reoperation.

• Journal of Chest Surgery
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• v.45 no.5
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• pp.295-300
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• 2012

Background: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. Materials and Methods: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. Results: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: $11.0{\pm}7.8%$ in the complex AVR group and $12.3{\pm}8.0%$ in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass ($152.4{\pm}52.6$ minutes vs. $109.7{\pm}22.7$ minutes, p=0.001), the quantity of allogenic blood products did not differ ($13.4{\pm}14.7$ units vs. $13.9{\pm}11.2$ units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ${\geq}5$ units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ${\geq}24$ hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. Conclusion: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.727-732
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• 2007

Background: The reciptents of aortic valve replacement or a Bentall operation usually display various degrees of mitral regurgitation. When deciding whether or not to correct the mitral regurgitation, one must consider its severity, underlying causes and operative risk. Recently, the operation method for correcting the concomitant mitral regurgitation has been done through aortic root to reduce the operation time and the cardiac trauma. We report our experiences that transaortic mitral valve commissuroplasty done with aortic valve replacement or a Bentall operation has been a simple, less invasive, effective method in the operative management of mitral valve regurgitation without significant organic changes. Material and Method: Between June 2002 and June 2005, twenty patients under-went mitral valve commissuroplasty via the aortic root with aortic valve replacement (n=14) or a Bentall operation (n=7). The mitral valve regurgitation of the patients didn't exceed a moderate (grade 2) degree and there was no significant organic disease. The preoperative diagnosis of MR was established by TTE and intraoperative TEE, and the patients were followed postoperatively by TTE. The operative technique was a simple anterolateral commissuroplasty of the mitral valve with a single mattress suture via the transaortic annular approach after excision of the aortic valve leaflets. Result: The mean patient age was 56.2 years and 65% (n=13) were male. The preoperative MR was mild (grade 1) in 9 (45%), mild to moderate in 8 (40%), and moderate (grade 2) in 3 (15%) patients. There were no operative mortalities. The MR improved in all patients (p=0.002) and the left ventricular ejection fraction (LV EF) improved in 14 (70%) patients (p=0.005). The mean cross-clamp time for the patients who under- went aortic valve replacement with transaortic mitral repair was $62.1{\pm}13.9 min$ and this was $137.5{\pm}7.2 min$ for the patients who underwent a Bentall operation with transaortic mitral repair. Conclusion: For selected patients without significant mitral organic disease, transaortic mitral valve commissuroplasty combined with aortic valve replacement or a Bentall operation may be a feasible, effective method without adding significant aortic cross clamping time and more cardiotomy.

• Journal of Chest Surgery
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• v.52 no.5
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• pp.376-379
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• 2019

Concomitant Loeys-Dietz syndrome (LDS) and hematologic malignancies are exceptionally rare. This is the first report of a patient operated on for aortic root dilation who had been previously diagnosed with LDS and B-cell-lymphoma. After completion of chemotherapy and complete remission, an elective valve-sparing aortic root replacement (using the David-V method) was performed. Due to the positive family history, preoperative genetic counseling was conducted, and revealed LDS with a TGFBR1 (transforming growth factor beta receptor type I) mutation in 6 probands of the family, albeit in 1 of them posthumously. This missense mutation has been previously described in relation to aortic dissection, but a causative relationship to malignancy has so far neither been proposed nor proven.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.436-442
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• 2017

Background: Dissection flaps in acute type A aortic dissection typically extend into the root, most frequently into the non-coronary sinus (NCS). The weakened root can be susceptible not only to surgical trauma, but also to future dilatation because of its thinner layers. Herein, we describe a new technique that we named the "neo-adventitia" technique to strengthen the weakened aortic root. Methods: From 2012 to 2016, 27 patients with acute type A aortic dissection underwent supracommissural graft replacement using our neo-adventitia technique. After we applied biologic glue between the dissected layers, we wrapped the entire NCS and the partial left and right coronary sinuses on the outside using a rectangular Dacron tube graft that served as neo-adventitia to reinforce the dissected weakened wall. Then, fixation with subannular stitches stabilized the annulus of the NCS. Results: There were 4 cases of operative mortality, but all survivors were discharged with aortic regurgitation (AR) classified as mild or less. Follow-up echocardiograms were performed in 10 patients. Of these, 9 showed mild or less AR, and 1 had moderate AR without root dilatation. There were no significant differences in the size of the aortic annulus (p=0.57) or root (p=0.10) between before discharge and the last follow-up echocardiograms, and no reoperations on the aortic roots were required during the follow-up period. Conclusion: This technique is easy and efficient for reinforcing and stabilizing weakened roots. Furthermore, this technique may be an alternative for restoring and maintaining the geometry of the aortic root. An externally reinforced NCS could be expected to resist future dilatation.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.786-790
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• 2006

An anastomotic pseudoaneurysm after the aortic replacement surgery is a rare complication which could be lethal when it ruptures. So it should be corrected whenever it is found after the aortic surgery. The authors performed three surgical corrections in 2 cases. The first case is type 8 chronic aortic dissection with abdominal aortic aneurysm. After an abdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm. We treated him with a thoracoabdominal aortic replacement. The second case is ruputred throacoabdominal aortic aneurysm. After a thoracoabdominal aortic replacement, the patient developed an anastomotic pseudoaneurysm in the proximal anastomosis. We treated her with aortic arch replacement. But She developed another pseudoaneurysm in the aortic root anastomotic site. So we performed secondary operation to reinforce the anastomosis. They all recovered from the operations without any complication and are being followed up.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.336-339
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• 1997

The surgical treatment of diseases of thoracic aorta has had much better success rate in recent years compaired to the past. Aortic aneurysms or dissections that extend along the entire thoracic aorta are usually approached in two or three stages. Recently we successfully perfofm d one-stage aortic replacement from the aortic root to the abdominal aorta in chronic DeBakey type I dissection. A 25 year-old man who had dyspnea on exertion (NYHA Fc II) and a Marfanoid feature was operated under the diagnosis of chronic type I dissection with severe aortic regurgitation. ' At operation, a huge ascending aorta with two intimal tearings was seen and the blood supply of intercostal arteries and right renal artery was done from the false lumen. Modified Bentall operation with total aortic replacement was done successfully, and the patient is being followed-up without major complications.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.719-723
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• 1997

We experienced a case of aneurysm of the sinus of Valsalva dissecting into the ventricular dseptum. This dissection was induced by paravalvular leakage after aortic and mitral valve replacement. This 37-year-old male was admitted via emergence room due to progressive dyspnea. He had undergone aortic valve replacement(carbomed c" 23 mm) and mitral valve replacement(carbomedic 31 mm) due to aortic regurgitation and mitral regurgitation about 6 years prior to admission and followed up regularly. The diagnosis was made by transthoracic and transesophageal echocardiography and reconfirmed by root aortography. The inlet of the ventricular septal aneurysmal sac was repaired by one layer suture with 3-0 prolene of the endocardium, epicardium and homograft muscle shoulder altogether. Postoperative course was uneventful and the patient was discharged on the 11th postoperative day. day.

• Journal of Chest Surgery
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• v.52 no.2
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• pp.109-111
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• 2019

We report the case of a female patient who underwent late reoperation following endocarditis surgery. The patient first underwent surgery at 22 years of age for endocarditis with aortic and tricuspid insufficiency. She underwent aortic root replacement with a homograft and tricuspid valve replacement with a tissue valve. Coronary artery bypass using the internal thoracic artery and ligation of the left main coronary artery were performed. Ten years later, failure of the homograft and the tricuspid valve developed. In the second operation, the patient underwent a successful Bentall operation and tricuspid valve replacement with a mechanical valve under deep hypothermia and retrograde cold cardioplegia without drainage.