Alessandro Favaro

Fate of the Aortic Root Late After Ross Operation

Background—The Ross operation is an alternative to mechanical aortic valve replacement in the young. Early dilatation of the pulmonary autograft root exposed to the systemic circulation has been reported. To define the prevalence of, risk factors for, and consequences of late autograft dilatation, outcome in all consecutive patients operated since May 1994 was reviewed. Methods and Results—Ninety one patients, 77 males and 14 females, with at least 1 year of follow-up underwent cross-sectional clinical and echocardiographic examination. Age at operation was 27±10 years (range 6 to 49), and the indication was aortic regurgitation in 54 (59%) patients and bicuspid valve was present in 62 (68%). End-points of the study were freedom from autograft dilatation (root diameter >4 cm or 0.21 cm/m2), from (moderate) autograft regurgitation and from reoperation. Follow-up (4.0±1.9, range 1 to 8 years) autograft root diameters were anulus, 29±4 mm (18–39); sinus of Valsalva, 38±7 mm (24–53); sinotubular junction, 37±6 mm (23–54); and ascending aorta, 37±5 mm (27–54). Late autograft dilatation was identified in 31 (34%) patients and regurgitation in 13 (14%), 7 of whom had autograft dilatation. At 7 years, freedom from dilatation was 42±8%, freedom from regurgitation was 75±8%, and freedom from reoperation was 85±10%. Cox proportional hazard analysis identified younger age (P =0.05), preoperative sinus of Valsalva (P =0.02), root replacement technique (P =0.03), and absence of pericardial buttressing (P =0.04) as predictive of autograft dilatation, whereas female sex (P =0.002), follow-up sinus of Valsalva (P =0.003), and sinotubular junction diameter (P =0.02) as predictive of autograft regurgitation. Conclusions—Autograft dilatation is common late after the Ross procedure, particularly in younger patients, in those with preoperative aortic aneurysm, and those having root replacement without support of anulus and sinotubular junction. Bicuspid aortic valve is not a risk factor. Significant autograft valve dysfunction affects a minority of patients, but it is more prevalent in those with autograft dilatation.

Left Atrial Wall Hematoma as a Consequence of Percutaneous Coronary Angioplasty

Intramural left atrial dissection and hematoma as a complication of a coronary stenting procedure is a very rare entity. We report the case of a 73-year-old man who underwent percutaneous coronary angioplasty for a severe stenosis of the left circumflex coronary artery, complicated by a left atrial intramural hematoma, and was successfully treated with via a minimally invasive port-access surgical approach.

Aortic valve replacement with a rapid deployment Edwards Intuity bioprosthesis using a completely video-guided approach

We describe the case of a 54-year-old female with severe aortic stenosis and a background of severe comorbidities including prior radiotherapy for Hodgkin’s lymphoma, splenectomy, severe chronic obstructive pulmonary disease, scleroderma with laryngeal and esophageal involvement, and systemic and pulmonary hypertension. The patient underwent totally video-guided aortic valve replacement through a minimally invasive right anterior thoracotomy (Video 1).

Redo After Failure of Aortic Homografts With a Rapid Deployment Valve

Homograft implantation in the aortic position was a common approach for full root aortic surgical procedures in the early 2000s. Reintervention after degeneration of such homografts remains a challenge. We report two cases of successful implantation of the Edwards Intuity Elite rapid deployment valve into patients with degeneration of existing aortic homograft implants leading to severe aortic regurgitation.

Edwards Prima Plus Stentless Bioprosthesis: Long-term clinical and hemodynamic results

Stentless aortic xenografts were introduced into clinical practice in order to improve clinical outcomes following aortic valve replacement for their better hemodynamic performance and durability. Edwards Lifesciences Prima Plus stentless xenograft (EPP) (Edwards Lifesciences, Irvine, CA, USA) is a bioprosthesis made of a porcine aortic root reinforced with Dacron fabric.