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506 SURGICAL CREATION OF AUTOLOGOUS PERICARDIAL NEO-AORTIC SINUSES TO MANAGE SINUS OF VALSALVA PATHOLOGY.
  1. N. Dhamija,
  2. H. Laks,
  3. J. Child,
  4. J. Odim
  1. Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA

Abstract

Objective We sought to evaluate the efficacy of creating glutaraldehyde-tanned autologous pericardial neosinuses to repair (exclude) sinus of Valsalva aortic root pathology.

Methods Over the last decade (1996-2005), 81 patients (mean age 46 ± 20 years) underwent aortic root repairs involving construction of neoaortic pericardial sinuses as a central feature. Sixty-seven (83%) patients were male. The etiology was congenital in 53% (43), including bicuspid aortic valve (30), ventricular septal defect (6), aortic coarctation (4), and connective tissue disorder in 15% (12), including Marfan's syndrome (9). Fifty-eight patients had an ascending aorta aneurysm and five patients experienced Type I dissection. Sixty-six patients had significant aortic regurgitation (AR) and 24 patients had concomitant AR/AS. Seventy-six patients had an aneurysmal non-coronary sinus; 37 and 25 patients had affected right and left coronary sinuses, respectively. Three patients had sinus ruptures into the right ventricle. Surgical approaches included creation of pericardial neosinuses (NCS: 75, RCS: 38, LCS: 24); AV repair (10 pericardial leaflet extensions, 21 subcommissuroplasties); AV replacement (39); ascending aorta repair (14 Hemashield grafts, 54 Dacron mesh wraps), and concomitant mitral valve and tricuspid repairs in 11 and 4 patients, respectively.

Results There was no early mortality (mean follow-up 23 ± 31 months). There was one death at 6.3 years due to complications following another cardiac operation. Nine patients required reoperation for recurrent AR and aneurysmal sinuses (6), and aortic aneurysms/dissections (3). The remaining patients demonstrated good AR (mean grade 1.3 ± 1.1; 3.2 ± 1.0 preoperatively) and aortic root statuses (mean diameter 34.3 ± 6.0 mm; 46.9 ± 12.3 mm preoperatively).

Conclusions Creating neo-aortic sinuses with autologous pericardium offers a promising simple approach to repair sinus-related pathology solely or as adjunctive surgical intervention for multi-level disease in the aortic root and ascending aorta.

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