Valve-sparing aortic root replacement in children: intermediate-term results
Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome...
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| Veröffentlicht in: | Interactive cardiovascular and thoracic surgery 2011-03, Vol.12 (3), p.415-419 |
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| creator | Patel, Nishant D Arnaoutakis, George J George, Timothy J Allen, Jeremiah G Alejo, Diane E Dietz, Harry C Cameron, Duke E Vricella, Luca A |
| description | Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2±0.8 cm (Z-score 7.7±2.9). Five (8.9%) had >2+ aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2+ AI and required aortic valve repair or replacement. No patient developed >2+ AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling. |
| doi_str_mv | 10.1510/icvts.2010.255596 |
| format | Article |
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Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2±0.8 cm (Z-score 7.7±2.9). Five (8.9%) had >2+ aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2+ AI and required aortic valve repair or replacement. No patient developed >2+ AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.</description><identifier>ISSN: 1569-9293</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1510/icvts.2010.255596</identifier><identifier>PMID: 21118834</identifier><language>eng</language><publisher>England</publisher><subject>Adolescent ; Aortic Aneurysm - etiology ; Aortic Aneurysm - mortality ; Aortic Aneurysm - surgery ; Aortic Valve - surgery ; Baltimore ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - mortality ; Child ; Child, Preschool ; Female ; Hospital Mortality ; Humans ; Infant ; Kaplan-Meier Estimate ; Loeys-Dietz Syndrome - complications ; Loeys-Dietz Syndrome - mortality ; Loeys-Dietz Syndrome - surgery ; Male ; Marfan Syndrome - complications ; Marfan Syndrome - mortality ; Marfan Syndrome - surgery ; Patient Selection ; Reoperation ; Replantation - adverse effects ; Replantation - mortality ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2011-03, Vol.12 (3), p.415-419</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-8114aa2816227ad57323532df61b4c36c43342635a497899eecb6322e82d2ea53</citedby><cites>FETCH-LOGICAL-c409t-8114aa2816227ad57323532df61b4c36c43342635a497899eecb6322e82d2ea53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21118834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Nishant D</creatorcontrib><creatorcontrib>Arnaoutakis, George J</creatorcontrib><creatorcontrib>George, Timothy J</creatorcontrib><creatorcontrib>Allen, Jeremiah G</creatorcontrib><creatorcontrib>Alejo, Diane E</creatorcontrib><creatorcontrib>Dietz, Harry C</creatorcontrib><creatorcontrib>Cameron, Duke E</creatorcontrib><creatorcontrib>Vricella, Luca A</creatorcontrib><title>Valve-sparing aortic root replacement in children: intermediate-term results</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2±0.8 cm (Z-score 7.7±2.9). Five (8.9%) had >2+ aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2+ AI and required aortic valve repair or replacement. No patient developed >2+ AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.</description><subject>Adolescent</subject><subject>Aortic Aneurysm - etiology</subject><subject>Aortic Aneurysm - mortality</subject><subject>Aortic Aneurysm - surgery</subject><subject>Aortic Valve - surgery</subject><subject>Baltimore</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infant</subject><subject>Kaplan-Meier Estimate</subject><subject>Loeys-Dietz Syndrome - complications</subject><subject>Loeys-Dietz Syndrome - mortality</subject><subject>Loeys-Dietz Syndrome - surgery</subject><subject>Male</subject><subject>Marfan Syndrome - complications</subject><subject>Marfan Syndrome - mortality</subject><subject>Marfan Syndrome - surgery</subject><subject>Patient Selection</subject><subject>Reoperation</subject><subject>Replantation - adverse effects</subject><subject>Replantation - mortality</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1569-9293</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kEtLAzEUhYMotlZ_gBuZnaupyc0kTdxJ8QUFN-o2pJlbjczLJFPw3ztja1f3HDjnwP0IuWR0zgSjN95tU5wDHTwIIbQ8IlMmpM41KHF80JpPyFmMX5QyTTk9JRNgjCnFiylZvdtqi3nsbPDNR2bbkLzLQtumLGBXWYc1NinzTeY-fVUGbG4HkzDUWHqbMB_lEI19leI5OdnYKuLF_s7I28P96_IpX708Pi_vVrkrqE65YqywFhSTAAtbigUHLjiUG8nWhePSFZwXILmwhV4orRHdWnIAVFACWsFn5Hq324X2u8eYTO2jw6qyDbZ9NEpwrUEADEm2S7rQxhhwY7rgaxt-DKNmZGj-GJqRodkxHDpX-_V-PXx5aPxD47841m23</recordid><startdate>201103</startdate><enddate>201103</enddate><creator>Patel, Nishant D</creator><creator>Arnaoutakis, George J</creator><creator>George, Timothy J</creator><creator>Allen, Jeremiah G</creator><creator>Alejo, Diane E</creator><creator>Dietz, Harry C</creator><creator>Cameron, Duke E</creator><creator>Vricella, Luca A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201103</creationdate><title>Valve-sparing aortic root replacement in children: intermediate-term results</title><author>Patel, Nishant D ; Arnaoutakis, George J ; George, Timothy J ; Allen, Jeremiah G ; Alejo, Diane E ; Dietz, Harry C ; Cameron, Duke E ; Vricella, Luca A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-8114aa2816227ad57323532df61b4c36c43342635a497899eecb6322e82d2ea53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Aortic Aneurysm - etiology</topic><topic>Aortic Aneurysm - mortality</topic><topic>Aortic Aneurysm - surgery</topic><topic>Aortic Valve - surgery</topic><topic>Baltimore</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Infant</topic><topic>Kaplan-Meier Estimate</topic><topic>Loeys-Dietz Syndrome - complications</topic><topic>Loeys-Dietz Syndrome - mortality</topic><topic>Loeys-Dietz Syndrome - surgery</topic><topic>Male</topic><topic>Marfan Syndrome - complications</topic><topic>Marfan Syndrome - mortality</topic><topic>Marfan Syndrome - surgery</topic><topic>Patient Selection</topic><topic>Reoperation</topic><topic>Replantation - adverse effects</topic><topic>Replantation - mortality</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Nishant D</creatorcontrib><creatorcontrib>Arnaoutakis, George J</creatorcontrib><creatorcontrib>George, Timothy J</creatorcontrib><creatorcontrib>Allen, Jeremiah G</creatorcontrib><creatorcontrib>Alejo, Diane E</creatorcontrib><creatorcontrib>Dietz, Harry C</creatorcontrib><creatorcontrib>Cameron, Duke E</creatorcontrib><creatorcontrib>Vricella, Luca A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Nishant D</au><au>Arnaoutakis, George J</au><au>George, Timothy J</au><au>Allen, Jeremiah G</au><au>Alejo, Diane E</au><au>Dietz, Harry C</au><au>Cameron, Duke E</au><au>Vricella, Luca A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Valve-sparing aortic root replacement in children: intermediate-term results</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2011-03</date><risdate>2011</risdate><volume>12</volume><issue>3</issue><spage>415</spage><epage>419</epage><pages>415-419</pages><issn>1569-9293</issn><eissn>1569-9285</eissn><abstract>Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2±0.8 cm (Z-score 7.7±2.9). Five (8.9%) had >2+ aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2+ AI and required aortic valve repair or replacement. No patient developed >2+ AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.</abstract><cop>England</cop><pmid>21118834</pmid><doi>10.1510/icvts.2010.255596</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Open Access Collection; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Aortic Aneurysm - etiology Aortic Aneurysm - mortality Aortic Aneurysm - surgery Aortic Valve - surgery Baltimore Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - mortality Child Child, Preschool Female Hospital Mortality Humans Infant Kaplan-Meier Estimate Loeys-Dietz Syndrome - complications Loeys-Dietz Syndrome - mortality Loeys-Dietz Syndrome - surgery Male Marfan Syndrome - complications Marfan Syndrome - mortality Marfan Syndrome - surgery Patient Selection Reoperation Replantation - adverse effects Replantation - mortality Retrospective Studies Risk Assessment Risk Factors Survival Rate Time Factors Treatment Outcome |
| title | Valve-sparing aortic root replacement in children: intermediate-term results |
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