Skip to main content

Advertisement

SpringerLink
Log in

Aortic valve reimplantation for aortic root aneurysms: trainer and trainee differences on long-term results

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The advantages of aortic valve-preserving surgery are still hampered by a higher rate of reoperations compared to root replacement with valved conduits. This study evaluates whether valve deterioration rate is related to the method or depends on stringent adherence to technical concepts, which might be lost once trainees perform this complex surgery on their own.

Methods

From 1991 to 2011, the David procedure was performed in 209 consecutive patients. Mean age was 57 ± 14 years. The patients were operated either by the senior author or trainees under his supervision (group 1, n = 130) or by surgeons on their own after training by the senior author (group 2, n = 79). Clinical and echocardiography data were evaluated pre- and postoperatively and at follow-up (mean 6.0 ± 4 years).

Results

In-hospital mortality was 1.5 % in group 1 and 5 % in group 2 (p = 0.29), and late mortality was 12 % (n = 12 in group 1 and n = 14 in group 2, p = 0.11), three were cardiac related. Nine patients (4.3 %) had to be reoperated; three for endocarditis in group 1, six for structural valve deterioration in group 2 (p = 0.14). The 9-year freedom from reoperation or aortic valve insufficiency (AI) ≥2° was 93 % in group 1 and 78 % in group 2 (p < 0.01). As groups showed differences in preoperative variables, results were compared also in a propensity matched subgroup. Despite no difference in perioperative results, long-term valve competence remained inferior in group 2.

Conclusions

With stringent adherence to technical concepts, structural valve deterioration may virtually be considerably reduced in aortic valve reimplantation. Once performing this operation on their own, trainees—after training by the senior—achieved results as independent surgeons well comparable to published series. As long-term performance seems to depend more on judgment of the geometry achieved intraoperatively than on technical steps, a means of measurement of effective coaptation height with a caliper might facilitate evaluation of perfect repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Leyh RG, Kallenbach K, Karck M, Hagl C, Fischer S, Haverich A (2003) Impact of preoperative aortic root diameter on long-term aortic valve function after valve sparing aortic root reimplantation. Circulation 108:II285–90

  2. Schäfers HJ, Pethig K, Borst HG (1996) Aortic valve reconstruction in ectasia of the aortic root and valve insufficiency. Z Kardiol 85:442–7

  3. David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M (2006) Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg 132:347–54

  4. Borst HG, Laas J (1993) Surgical treatment of thoracic aortic aneurysms. Adv Cardiac Surg 4:47–87

  5. Aybek T, Sotiriou M, Wöhleke T et al (2005) Valve opening and closing dynamics after different aortic valve-sparing operations. J Heart Valve Dis 14:114–20

  6. Moritz A, Risteski P, Dogan S et al (2007) Six stitches to create a neosinus in David-type aortic root resuspension. J Thorac Cardiovasc Surg 133:560–2

  7. Dalton SJ, Ghosh AJ, Zafar N, Riyad K, Dixon AR (2010) Competency in laparoscopic colorectal surgery is achievable with appropriate training but takes time: a comparison of 300 elective resections with anastomosis. Colorectal Dis 12:1099–104

  8. Palan J, Gulati A, Andrew JG, Murray DW, Beard DJ, EPOS study group (2009) The trainer, the trainee and surgeons’assistant: clinical outcomes following total hip replacement. J Bone Joint Surg Br 91:928–34

  9. Perry GJ, Helmcke F, Nanda NC, Byard C, Soto B (1987) Evaluation of aortic insufficiency by Doppler colour flow mapping. J Am Coll Cardiol 9:952–9

  10. Monsefi N, Bakhtiary F, Moritz A (2010) Supra-annular stitch to avoid distortion of the right coronary cusp in aortic root resuspension. J Heart Valve Disease 19:371–3

  11. Bakhtiary F, Monsefi N, Trendafilow M, Wittlinger T, Doss M, Moritz A (2009) Modification of the David procedure for reconstruction of incompetent bicuspid aortic valves. Ann Thorac Surg 88:2047–9

  12. Kouchoukos NT, Wareing TH, Murphy SF, Perillo JB (1991) Sixteen-year experience with aortic root replacement. Results of 172 operations. Ann Surg 214:308–18, discussion 318–20

  13. De Paulis R, De Matteis GM, Nardi P, Scaffa R, Buratta MM, Chiarello L (2001) Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit. Ann Thorac Surg 72:487–94

  14. Bakhtiary F, Monsefi N, Herrmann E et al (2011) Long-term results and cusp dynamics after aortic valve resuspension for aortic root aneurysms. Ann Thorac Surg 91:478–84

  15. Kunihara T, Aicher D, Rodionycheva S et al (2012) Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg 143:1389–95

  16. Kalllenbach K, Baraki H, Khaladj N et al (2007) Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade? Ann Thorac Surg 83:S764–8, discussion S785-90

  17. Hagl C, Strauch JT, Spielvogel D et al (2003) Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival? Ann Thorac Surg 76:698–703

  18. Etz CD, Bischoff MS, Bodian C et al (2010) The Bentall procedure: is it the gold standard? A series of 597 consecutive cases. J Thorac Cardiovasc Surg 140:64–70

  19. Erasmi AW, Stierle U, Bechtel JF, Schmidtke C, Sievers HH, Kraatz EG (2003) Up to 7 years’ experience with valve-sparing aortic root remodelling/reimplantation for acute type A dissection. Ann Thorac Surg 76:99–104

  20. Leontyev S, Trommer C, Subramanian S et al (2012) The outcome after valve-sparing (David) operation in 179 patients: a single-centre experience. Eur J Cardiothorac Surg 42:261–6, discussion 266–7

  21. Schäfers HJ, Bierbach B, Aicher D (2006) A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg 132:436–8

Download references

Conflicts of interest disclosure

There is no conflict of interest to be disclosed.

Author information

Authors and Affiliations

  1. Department of Thoracic- and Cardiovascular Surgery, Goethe University Hospital, 60590, Frankfurt a.M., Germany

    Nadejda Monsefi, Patrick Primbs, Aleksandra Miskovic & Anton Moritz

  2. Department of Cardiovascular Surgery, Hietzing Hospital, Wolkersbergenstr.1, 1130, Vienna, Austria

    Sandra Folkmann

Authors
  1. Nadejda Monsefi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Primbs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aleksandra Miskovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandra Folkmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anton Moritz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadejda Monsefi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Monsefi, N., Primbs, P., Miskovic, A. et al. Aortic valve reimplantation for aortic root aneurysms: trainer and trainee differences on long-term results. Langenbecks Arch Surg 400, 259–266 (2015). https://doi.org/10.1007/s00423-014-1222-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-014-1222-6

Keywords

Search

Navigation