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Ann Thorac Surg 2000;69:783-784
© 2000 The Society of Thoracic Surgeons

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Commentary

^a Division of Cardiac Surgery, Massachusetts General Hospital, Warren 735, 32 Fruit St, Boston, MA, USA 02114,

e-mail: ahilgenberg{at}partners.org

Invited commentary

Doctor Svensson and colleagues are to be congratulated for their excellent results in a diverse group of patients with ascending aortic aneurysms and aortic valve pathology. The hospital survival rates and neurologic outcomes are the gold standards to which all surgeons working in this field will aspire. The selection of appropriate patients for each of the techniques described for management of the aortic valve pathology requires careful judgment, and considerable artistry and a learning curve are necessary to successfully perform valve-sparing operations.

The article describes a new technique of preserving the aortic valve which is different from those described by Sarsam and Yacoub and by David [1, 2]. The operation described by Svensson and coworkers is an inclusion technique in which the aortic sinuses are not excised and the coronary arteries are not formed into buttons and mobilized. These aspects of the procedure may be desirable from the standpoint of hemostasis and maintenance of geometry of the aortic valve commissures, but I am concerned about the risk of pseudoaneurysm formation at the aortic and coronary anastomoses. Several previous studies have identified this risk in relation to composite root replacement using inclusion techniques, and my group has demonstrated a complete absence of late pseudoaneurysms with excision of the aortic wall and coronary button technique.

The artistry required in the valve-sparing operations involves selecting patients with suitable annulus size and valve leaflet quality, choosing the appropriate graft diameter, and making the scalloped incisions in the graft the correct lengths. Longer follow-up in more patients will be necessary to assess the durability of the aortic valve repair and the risk of late pseudoaneurysm formation. The authors have demonstrated that excellent early and long-term results are possible in complex aortic root pathology using an individualized approach with several different operative strategies to eliminate the aneurysm and restore aortic valve function.

References

1. Sarsam M.A.I., Yacoub M. Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg 1993;105:435-438.[Abstract]
2. David T.E., Feindel C.M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1992;103:617-622.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hilgenberg, A. D. Search for Related Content PubMed Articles by Hilgenberg, A. D. Related Collections Related Article