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Selective Replacement Of The Ascending Aorta And Non-coronary Sinus ("hemi-root") For Bicuspid Aortic Valve Aortopathy

Michael Sabetai, George Belitsis, Mario Petrou.
Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.


OBJECTIVE: We evaluated the role of selective replacement of the ascending aorta (AA) and the non-coronary sinus of Valsalva ("hemi-root") in bicuspid aortic valve (BAV) patients with modest aortic root (ARo) dilatation (35 to 45 mm).
METHODS: Between July 2002 and October 2010 we performed 58 AoR procedures including total replacement, valve-sparing and selective sinus remodeling. 4 patients (all male) with a mean age of 55 years (range 39-71) underwent AA+hemi-root replacement, 3 of whom had also had AVR for pathological BAV and 1 had a valve-sparing procedure. Other concomitant procedures in this sub-group included CABG and myectomy of the LVOT. The mean diameters of the ARo and AA were 41 (38-44) and 46 (44-52) mm, respectively. Selective replacement of the AA+hemi-root was performed using a GelsealTM graft (30-32 mm) fashioned proximally with a "tongue extension".
RESULTS: In hospital survival was 100%. Mean bypass and cross-clamp times were 149 (109-166) and 113 (85-134) min, respectively. None of the patients required re-exploration for bleeding. All patients remain clinically well at follow-up with stable ARo dimensions on surveillance imaging.
CONCLUSIONS: Prophylactic replacement of the AA and "hemi-root" using a tailored tube graft is a relatively simple solution in patients with BAV with modestly enlarged aortic dimensions. Although this technique may be criticised for leaving residual pathological tissue in the left and right coronary sinuses we know from other studies that the greatest haemodynamic stresses occur in the antero-lateral (greater curve) of the aortic root and ascending aorta. Long-term follow up is essential.
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