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Aortic valve disease

Aortic Root Enlargement to Mitigate Patient-Prosthesis Mismatch: Do Early Adverse Events Justify Reluctance?

Concomitant aortic root enlargement at the time of surgical aortic valve replacement is an option to avoid patient-prosthesis mismatch. In this single-center study, 4,210 patients underwent aortic valve replacement, of which 171 had concomitant aortic root enlargement. In analysis of matched patient outcomes, there were similar numbers of postoperative bleeding and pericardial effusion events, and no difference in early deaths. The authors conclude that aortic root enlargement can be performed safely with no increase in early postoperative surgical complications. 

Comparison of Early Patency Rate and Long-Term Outcomes of Various Techniques for Reconstruction of Segmental Arteries During Thoracoabdominal Aortic Aneurysm Repair

Henmi and colleagues analyzed the results of different reimplantation techniques of segmental arteries during thoracoabdominal aortic aneurysm repair. Among 172 patients, 111 underwent segmental artery reconstruction via graft interposition, 38 via single-cuff anastomosis, and 23 via island reconstruction. The graft interposition technique had a poor patency rate. Island reconstruction and single-cuff anastomosis offered better patency, however island reconstruction required reoperation for patch aneurysm.

Minimizing Permanent Pacemaker Following Repositionable Self-Expanding Transcatheter Aortic Valve Replacement

Using an approach that minimizes valve depth relative to the membranous septum, the authors reduced the need for permanent pacemaker placement to a reliable and predictable 3% compared to the accepted standard of 10%.

A Comparison of Two Strategies for Aortic Valve-sparing Root Replacement

Colleagues from Italy and Germany compared the short- and mid-term outcomes of the straight tube graft (David-I) and the Valsalva graft in 232 patients undergoing an isolated David procedure. The two groups did not differ significantly in 30-day mortality (1% vs 2%), late survival (p = 0.799), or valve-related reoperation (p = 0.241). Although with more cusp repairs (22% vs 4%), patients with Valsalva graft showed a higher incidence of aortic insufficiency ≥ II° after surgery (17% vs 0%) and at follow-up (39% vs 22%).

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