Multinational and Cross-Sectional Survey on Valve-Sparing Aortic Replacement Controversies

pp. 118-129

Authors

  • Germán A. Fortunato Department of Cardiovascular Surgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina; Department of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada https://orcid.org/0000-0002-8613-627X
  • Martín Misfeld Departamento de Cirugía Cardiotorácica, Royal Prince Alfred Hospital, Sídney, Australia; Institute of Academic Surgery, RPAH, Sídney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sídney, Australia; Sydney Medical School, University of Sydney, Australia
  • David Tirone Department of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada
  • Christopher M. Feindel Departamento de Cirugía Cardíaca, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canadá
  • Hans-Joachim Schäfers Departamento de Cirugía Cardiovascular y Torácica, Saarland University Medical Center, Homburg/Saar, Alemania
  • Michael A. Borger Departamento Universitario de Cirugía Cardíaca, Heart Center, University of Leipzig, Leipzig, Alemania
  • Joseph Coselli División de Cirugía Cardiotorácica, Departamento de Cirugía de Michael E. DeBakey, Baylor College of Medicine, Houston, EE.UU.
  • Ricardo Marenchino Departamento de Cirugía Cardiovascular, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  • Vadim Kotowicz Departamento de Cirugía Cardiovascular, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

DOI:

https://doi.org/10.7775/rac.es.v91.i2.20612

Abstract

Background: The valve-sparing aortic root replacement (VSAR) has been established as a successful procedure for aortic root
aneurysms, Marfan's syndrome, bicuspid valves, and aortic dissections. However, there is a need for a consensus opinion
regarding key aspects of VSAR.
Methods: A literature review was performed regarding the most frequent debates and controversies in VSAR. An online survey
was developed based on this information, and sent to surgeons with known expertise in VSAR regarding their opinion on
patient-related factors, technical aspects, echocardiography, research, training, and the future of VSAR.
Results: Twenty surgeons completed the survey. The reduction of left ventricular ejection fraction was considered a contraindication to VSAR when severe by 14/20 surveyed. The aortic annulus diameter cutoff point for the remodeling was heterogenous
among participants. All of them felt that VSAR is safe for the Marfan´s syndrome population and bicuspid valves.
For type A dissections, 11/20 preferred this procedure only in young patients. Regarding to graft sizing, the height of the
interleaflet triangle (8/20) and the sino-tubular diameter (7/20) were the more frequent considered parameters. Surgeons
reported a 7% of failure rate, leading to conversion to Bentall surgery, and a 26% change of strategy intraoperatively. A minimally
invasive approach was not considered to improve results. Most of the surgeons agreed that VSAR should be performed
by high-experienced surgeons.
Conclusions: The VSAR has been accepted as a treatment option for the aortic root´s aneurysms, and even though there is
still not possible to reach a final consensus, a valuable experience from the most relevant surgeons in the field is presented.

 

How to cite this article:

Fortunato GA, Misfeld M, Tirone D, Feindel CM, Schäfers HJ, Borger MA et al. Multinational and Cross-Sectional Survey on Valve-Sparing Aortic Replacement Controversies. Rev Argent Cardiol 2023;91:118-9
https://doi.org/10.7775/rac.v91.i2.20612

 

 

 

 

 

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Published

2023-05-15

Issue

Rev Argent Cardiol 2023 Vol. 91 Issue 2

Section

ORIGINAL ARTICLES

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Copyright (c) 2023 Argentine Journal of Cardiology

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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