Yacoub II Valve Conserving Operation for Aortic Root Remodeling

Since its introduction in 1982, the aortic root remodeling procedure, known as Yacoub's procedure, has gained widespread recognition and acceptance. This can be attributed to its ability to circumvent the adverse consequences associated with anticoagulation therapy, replicate natural blood flow characteristics—particularly at the coronary ostia—alleviate shear stress on the aortic leaflets, and, most important, preserve the dynamic nature of the aortic root 1). The remodeling procedure has been applied to various aortic wall pathologies, including aortic dissections, aortic aneurysms, and ruptured sinus of Valsalva. 
 
After nearly four decades of expertise, Professor Magdi Yacoub published novel modifications to the Yacoub remodeling procedure. These enhancements were designed to optimize the physiological impact of the neo-aortic sinuses by maximizing their longitudinal and horizontal curvatures while simultaneously reducing the diameter of the sinotubular junction (STJ) (2). 
 
In this video, the authors present the case of a 58-year-old patient who presented with acute aortic dissection (Stanford A). The video demonstrates the surgical technique for the "New Approach for Shaping the Aortic Sinuses and Preserving Dynamism in the Remodeling Operation (2)," commonly referred to as the Yacoub II procedure. Throughout the video, the authors highlight the technical differences between the Yacoub I and Yacoub II procedures. 
 
During regular follow-up examinations two years after the operation, the patient's aortic valve was found to be competent, and the annulus was not dilated. To assess the blood flow pattern, MRI 4-dimensional flow was utilized, revealing the restoration of laminar systolic flow and physiological blood vortices at the coronary ostia. Additionally, 3D segmentation of the neo-aortic root sinuses was performed, providing a clear delineation of the neo-physiological aortic root anatomy. 

References

1. Frcs MAIS, Frcs MY. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105(3):435-438. doi:10.1016/S0022-5223(19)34225-4
2. Yacoub MH, Ahmed A, Hosny H, et al. A New Technique for Shaping the Aortic Sinuses and Conserving Dynamism in the Remodeling Operation. Published online 2021. doi:10.1016/j.athoracsur.2020.10.036

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