• Bicuspid aortic valve
• Reimplantation
• Remodeling
• Tricuspid aortic valve
• Valve-sparing aortic root replacement

• Imaging
• Postoperative
• Thoracic aorta

• Aortic remodeling
• Bentall
• aortic root
• valve repair
• valve-sparing

Significant dilemma exists regarding the management of the aortic root pathology in acute aortic dissections. Several strategies for both repair and replacement exist and there is a lack of clarity on the superiority of one over the other. Important factors that influence management strategies include involvement of the sinuses, the competence of the aortic valve, the presence of Marfans syndrome, and connective tissue disorders, as well as availability of surgical expertise. The wide variability in these factors makes it unlikely for any one technique to be suitable for the management of all aortic roots pathology.

• aortic dissection
• limited root repair
• root replacement

• Normal pulmonary artery diameter
• Pulmonary artery
• Pulmonary artery aneurysm

• Aortic insufficiency
• Heart failure
• Left ventricular assist device
• Proximal ascending aorta size

Ascending thoracic aorta disease is often a life-threatening condition. Aortic aneurysm and aortic dissection are the most frequent ascending aorta diseases requiring surgical intervention. Surgical repair techniques of the ascending aorta are various; they include reconstruction of the ascending aorta by using a graft with or without a prosthetic valve, reconstruction with a composite artificial graft or using a biological graft, and reconstruction of the ascending aorta with a composite graft preserving the native valve and arch repair. The radiologist plays a key role in the identification of post-operative complications; differentiation from normal postoperative findings is fundamental. Our aim is to discuss the main diseases affecting the ascending aorta requiring surgery and the different techniques used to treat them. We also discuss the normal computed tomography (CT) imaging findings and after-surgery complications.

• Bentall-De Bono procedure
• ascending aorta-surgery
• elephant-trunk procedure
• graft
• post-operative CT imaging
• post-operative complications

• aorta and great vessels
• congenital heart disease

The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique.

Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression.

The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35).

Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.

• Aorta
• Aortic Diseases
• Aortic Valve
• Cardiac Surgical Procedures
• Thoracic

• David
• VSRR
• aorta
• aortic surgery
• root surgery
• valve sparing

Background  The Florida (FL) Sleeve procedure was introduced as a simplified approach for valve-sparing correction of functional Type I aortic insufficiency (AI) associated with aortic root aneurysms. In this study, short- and long-term outcomes after the FL Sleeve procedure were investigated.

Methods  From May 2002 to January 2016, 177 patients underwent the FL Sleeve procedure. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter, left ventricular ejection fraction, and degree of AI (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4) were evaluated by echocardiography.

Results  Mean ± standard deviation of age was 49.41 ± 15.37 years. Survival rate was 98% at 1 year, 97% at 5 years, and 93% at 8 years. Freedom from reoperation was 99% at 1 year and 98% at 2 to 8 years. Three patients (1.69%) died during hospitalization. Three patients (1.69%) developed periprocedural stroke. Postoperative follow-up echocardiography was available in 140 patients at 30 days, and 31 patients at 5 years. AI grade significantly improved from baseline at 30 days (2.18 ± 1.26 vs. 1.1 ± 0.93, p  < 0.001) and at 5 years (2.0 ± 1.23 vs. 1.45 ± 0.88, p  = 0.04). Preoperative mean LVEDD significantly decreased from 52.20 ± 6.73 to 46.87 ± 8.40 ( p  < 0.001) at 30 days, and from 53.22 ± 7.07 to 46.61 ± 10.51 ( p  = 0.01) at 5 years.

Conclusions  The FL Sleeve procedure is a safe, effective, and durable treatment of aortic root aneurysm and Type I AI. Long-term survival and freedom from reoperation rates are encouraging.

• Aortic root aneurysm
• Aortic root surgery
• Marfan syndrome

• Aorta
• Composite graft
• Endoleak
• Postsurgical aorta
• Pseudoaneurysm
• Ross procedure
• Supracoronary graft
• TEVAR

• 4D MRI
• Ascending thoracic aortic aneurysms
• Bicuspid aortic valve
• Computational fluid dynamics

• Aortic valve
• Force measurements
• Functional aortic annulus
• Repair techniques

• 2D echocardiography
• Ascending aortic aneurysm
• CT aortogram
• Cardiac MRI

• Aortic Diseases/diagnosis
• Aortic Diseases/surgery
• Echocardiography/methods
• Humans
• Image Enhancement/methods
• Magnetic Resonance Angiography/methods
• Postoperative Care/methods
• Preoperative Care/methods
• Prognosis
• Tomography, X-Ray Computed/methods
• Treatment Outcome
• Vascular Surgical Procedures/methods

We report a case of chronic type A dissection and aneurysm of the sinus of Valsalva after a motor bike accident which remained undetected for 20 years. It was successfully treated with a modified valve-preserving technique. The noncoronary sinus formed a 4.5 × 5.0 cm large and heavily calcified aneurysm, compressing the right atrium and right coronary artery. The pathology was limited to the noncoronary sinus area and here was the annulus dilatated but the remaining sinuses and annulus and the cusps were intact. We have therefore performed a one-third or partial-David procedure with a satisfactory result.

• aortic disease
• cardiovascular surgery
• trauma

• Aortic prolapse
• Aortic repair
• Aortic valve
• Echocardiography

• Aorta, Thoracic
• Aortic Aneurysm, Thoracic/diagnosis
• Aortic Aneurysm, Thoracic/surgery
• Aortic Aneurysm, Thoracic/therapy
• Aortic Diseases/diagnosis
• Aortic Diseases/surgery
• Aortic Diseases/therapy
• Cardiology/standards
• Humans
• Thoracic Surgery/standards
• United States

To evaluate the impact and safety of different surgical techniques for aortic root replacement (ARR) on early and late morbidity and mortality in septuagenarians undergoing ARR.

Ninety-five patients (73.8 ± 3.2 years) were operated and divided into three groups according to the aortic root procedure; MECH-group (n = 51) patients with a mechanical composite graft, BIO-group (n = 22) patients with a customized biological composite graft, and REIMPL-group (n = 22) patients with a valve sparing aortic root reimplantation (David I). In 42.1% (40/95) of these patients the aortic arch was replaced. Follow-up was completed in 95.2% (79/83) of in-hospital survivors.

Hospital mortality was 12.6% (12/95) in the entire population (MECH. 15.7% (8/51), BIO 19.7% (4/22), REIMPL 0% (0/22); p = 0.004). Two patients died intraoperatively. The most frequent postoperative complications were prolonged mechanical ventilation ((>48 h) in 16.8% (16/93) (MECH. 7% (7/51), BIO 36.4% (8/22), REIMPL 4.5% (1/22); p = 0.013) and rethoracotomy for postoperative bleeding in 12.6% (12/95) (MECH. 12% (6/51), BIO 22.7% (5/22), REIMPL 4.5% (1/22); p = 0.19). Nineteen late deaths (22.9%) (19/83) (MECH 34.8% (15/43), BIO 16.7% (3/18), REIMPL 4.5% (1/22); p = 0.012) occurred during a mean follow-up of 41 ± 42 months (MECH 48 ± 48 months, BIO 25 ± 37 months, REIMPL 40 ± 28 months, p = 0.028). Postoperative NYHA class decreased significantly (p = 0.017) and performance status (p = 0.027) increased for the entire group compared to preoperative values.

Our data indicate that valve sparing aortic root reimplantation is safe and effective in septuagenarians, and is associated with low early and late morbidity and mortality.