Francesco Nappi1, Antonio Nenna2, Tommasangelo Petitti3, Cristiano Spadaccio4, Ivancarmine Gambardella5, Mario Lusini2, Massimo Chello2, Christophe Acar6. 1. Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France. Electronic address: francesconappi2@gmail.com. 2. Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy. 3. Department of Public Health and Statistics, Università Campus Bio-Medico di Roma, Rome, Italy. 4. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom; University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom. 5. Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 6. Department of Cardiac Surgery, Hopital La Pitie Salpetriere, Paris, France.
Abstract
OBJECTIVE: The most efficient surgical approach to severe aortic valve disease in the young adult is still debated: cryopreserved aortic allograft offers excellent hemodynamic and avoid anticoagulation, but long-term durability is influenced by structural valve deterioration (SVD). This study aimed to describe long-term results of aortic allografts and to identify factors influencing long-term durability. METHODS: From January 1993 to August 2010, 210 patients underwent aortic allograft replacement via the free-hand subcoronary implantation technique (N = 55) or root replacement with coronary reimplantation (N = 155). Clinic and echocardiographic follow-up was updated to April 2016. RESULTS: Overall mortality and cardiac mortality occurred in 80 (38.1%) and 64 (30.5%) patients, respectively. Reoperation was required in 69 cases (32.8%), whereas SVD required reoperation in 57 cases (27.1%). No early endocarditis occurred, whereas late endocarditis occurred in 4 patients. The free-hand technique seems to be associated with improved left ventricular remodeling compared with the root-replacement technique, and smaller allograft size represents a predictor of reoperation independently on the surgical technique used. In the overall population, there were 44 women of childbearing age, and 37 patients remained pregnant during the follow-up of the study. No differences were found in the clinical outcomes among women who had children and who did not. CONCLUSIONS: Cryopreserved allograft is a valid option, especially in complex infective endocarditis and in women of childbearing age. A careful choice of allograft size and implantation technique can reduce the risk of SVD.
OBJECTIVE: The most efficient surgical approach to severe aortic valve disease in the young adult is still debated: cryopreserved aortic allograft offers excellent hemodynamic and avoid anticoagulation, but long-term durability is influenced by structural valve deterioration (SVD). This study aimed to describe long-term results of aortic allografts and to identify factors influencing long-term durability. METHODS: From January 1993 to August 2010, 210 patients underwent aortic allograft replacement via the free-hand subcoronary implantation technique (N = 55) or root replacement with coronary reimplantation (N = 155). Clinic and echocardiographic follow-up was updated to April 2016. RESULTS: Overall mortality and cardiac mortality occurred in 80 (38.1%) and 64 (30.5%) patients, respectively. Reoperation was required in 69 cases (32.8%), whereas SVD required reoperation in 57 cases (27.1%). No early endocarditis occurred, whereas late endocarditis occurred in 4 patients. The free-hand technique seems to be associated with improved left ventricular remodeling compared with the root-replacement technique, and smaller allograft size represents a predictor of reoperation independently on the surgical technique used. In the overall population, there were 44 women of childbearing age, and 37 patients remained pregnant during the follow-up of the study. No differences were found in the clinical outcomes among women who had children and who did not. CONCLUSIONS: Cryopreserved allograft is a valid option, especially in complex infective endocarditis and in women of childbearing age. A careful choice of allograft size and implantation technique can reduce the risk of SVD.
Authors: Francesco Nappi; Sanjeet Singh Avtaar Singh; Mario Lusini; Antonio Nenna; Ivancarmine Gambardella; Massimo Chello Journal: Ann Transl Med Date: 2019-09
Authors: Emanuela S Fioretta; Sarah E Motta; Valentina Lintas; Sandra Loerakker; Kevin K Parker; Frank P T Baaijens; Volkmar Falk; Simon P Hoerstrup; Maximilian Y Emmert Journal: Nat Rev Cardiol Date: 2020-09-09 Impact factor: 32.419
Authors: Francesco Pollari; Cristiano Spadaccio; Michela Cuomo; Massimo Chello; Antonio Nenna; Theodor Fischlein; Francesco Nappi Journal: Ann Transl Med Date: 2020-12