Modified Reimplantation of Tricuspid Aortic Valve in a Patient With Type I DeBakey Acute Aortic Dissection

Optimal treatment of the acute type A dissection is still controversial. The current guidelines give indistinct recommendations about which surgical valve-sparing procedure should be performed when aortic dissection occurs and which method of cannulation should be used for appropriate antegrade perfusion. Cannulation of the innominate artery has been a perfect alternative for 20 years, including in patients with acute type A aortic dissection (1). However, the published data contain fewer reports about this approach than about axillary or femoral cannulation. Compared with axillary or femoral artery cannulation, innominate artery cannulation has several advantages: absence of the need for a second incision, higher flow rate, and antegrade cerebral perfusion (2, 3). Today, aortic valve reimplantation technique is performed relatively rarely (<10%) in patients with acute type A aortic dissection (4). This type of surgery requires higher surgical skills and is used with caution in this category of patients. Here, the authors present innominate artery cannulation and modified reimplantation of tricuspid aortic valve in a young man with type I DeBakey acute aortic dissection (5, 6). Postoperative echocardiography one year later after surgery showed a satisfactory result of the procedure with good aortic valve function. Coaptation zone of the reimplanted valve was type A according to Pethig classification (7).

References

1. Banbury MK, Cosgrove DM III. Arterial cannulation of the innominate artery. Ann Thorac Surg. 2000;69:957.
2. Gaitanakis S, Baikoussis NG, Triantafyllou K. Innominate artery cannulation as standard technique for scending Aorta and Aortic Arch Surgery. Heart Lung Circ. 2019 Jul;28(7):e119.
3. Preventza O, Garcia A, Tuluca A, Henry M, Cooley DA, Simpson K, et al. Innominate artery cannulation for proximal aortic surgery: outcomes and neurological events in 263 patients. Eur J Cardiothorac Surg. 2015 Dec;48(6):937-42; discussion 942.
4. Mosbahi S, Stak D, Gravestock I, Burgstaller JM, Steurer J, Eckstein F, et al. A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection. Eur J Cardiothorac Surg. 2019 Feb 1;55(2):201-209.
5. Boldyrev S, Barbukhatty K, Porhanov V. A novel tool to facilitate crimping suture placement for a modified David V/Miller aortic root replacement. Aorta (Stamford). 2014;2:161-166.
6. Cameron D, Vricella L. Valve sparing aortic root replacement with the valsalva graft. OpTech Thorac Cardiovasc Surg. 2009;14:297-308.
7. Pethig K, Milz A, Hagl C, Harringer W, Haverich A. Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure. Ann Thorac Surg. 2002 Jan;73(1):29-33.

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.