Anterior longitudinal aortotomy in aortic valve replacement

General Thoracic and Cardiovascular Surgery volume 64, pages87–92(2016)Cite this article

Abstract

Objectives

We adopted an anterior longitudinal aortotomy in some cases of aortic valve replacement (AVR), and report them here. The potential of this method is also discussed.

Methods

We analyzed the data on 24 patients (75.5 ± 7.8 years of age) who had undergone AVR through anterior longitudinal aortotomy. The indications for surgery were prosthetic valve complication in 5 patients, aortic stenosis (AS) with left ventricular outflow tract stenosis (LVOTS) in 16 patients, and aortic regurgitation with moderately dilated ascending aorta in 3 patients. The Konno procedure was performed in 6 cases with small aortic annuli. A longitudinal aortotomy was made at the aortic root along the left side of the right coronary ostium, and extended beyond the right coronary annulus to the interventricular septum as needed.

Results

Bioprostheses (21.1 ± 1.7 mm) were used in 23 patients and a 21-mm mechanical valve for one (a 59-year-old man). One high-risk patient died of low output syndrome, leading to a mortality rate of 4.2 %. All other patients recovered well, though atrioventricular block occurred in 2 cases.

Conclusions

Anterior longitudinal aortotomy provides a good field of vision at the aortic annulus and the flexibility to develop into anterior annular enlargement. Major indications for this approach are small sino-tubular junction and very small aortic annulus. This approach could be an attractive option in AVR for cases of AS with small aortic annuli and LVOTS. It could also be useful for AVR cases with moderately dilated ascending aorta requiring aortoplasty.

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Author information

Affiliations

  1. Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan

    Kanji Matsuzaki, Yohei Kudo, Akihiko Ikeda, Taisuke Konishi & Tomoaki Jikuya

Authors
  1. Kanji Matsuzaki
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  2. Yohei Kudo
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  3. Akihiko Ikeda
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  4. Taisuke Konishi
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  5. Tomoaki Jikuya
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Corresponding author

Correspondence to Kanji Matsuzaki.

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The authors have no conflicts of interest to disclose.

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Matsuzaki, K., Kudo, Y., Ikeda, A. et al. Anterior longitudinal aortotomy in aortic valve replacement. Gen Thorac Cardiovasc Surg 64, 87–92 (2016). https://doi.org/10.1007/s11748-015-0600-5

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Keywords

  • Anterior longitudinal aortotomy
  • Aortic valve replacement
  • Konno procedure
  • Small aortic annulus
  • Left ventricular outflow tract stenosis