WL Gore

Abstract:

The first aortic valve homograft was implanted by Sir Donald Ross in 1962. Since then, over 25,000 aortic homografts have been implanted worldwide. Unfortunately, the current cryopreservation method promotes a degenerative process leading to progressive homograft fibrosis and calcification. Valve durability of fresh allografts appears to be superior to cryopreserved grafts. The main indications of aortic valve replacement with a homograft are endocarditis, rheumatic disease, bicuspid and dystrophic aortopathies. Our experience with 210 aortic homografts implanted over a 10-year period is reported. We describe the different implantation techniques with particular emphasis on the current technique of choice, namely homograft root replacement. Approximately one-fourth of all aortic homografts will experience structural valve deterioration at 12 years. Structural homograft valve deterioration translates predominately into valve insufficiency and less frequently into stenosis. Young recipient age it appears is the major determinant of reoperation. Predictors of early and late mortality are discussed.

Authors:

Francesco Nappi, MD, PhD, Consultant Cardiac Surgeon, Centre Cardiologique du Nord, St. Denis, France, Nawwar Al-Attar, PhD, FRCS, FETCS, Consultant Cardiac Surgeon, Golden Jubilee National Hospital, Clydebank, The United Kingdom, Cristiano Spadaccio, MD, Phd, University Campus BioMedico, Rome, Italy, Massimo Chello, MD, Full Professor of Cardiac Surgery, University Campus BioMedico, Rome, Italy, Mario Lusini, MD, PhD, Department of Cardiac Surgery, University Campus BioMedico, Rome, Italy, Christophe Acar, MD, Professor of Cardiac Surgery, Pitié Salpetriere, Paris, France

PMID:  24700229

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Abstract:

Endovascular aneurysm repair is now the preferred method of abdominal and thoracic aneurysm repair. Until recently, the limitation with this technology has been preservation of the visceral vasculature, hypogastric arteries, and the great vessels. The Zenith® Fenestrated (Cook, Bloomington, IN) is the first device available for use in the US for treatment of para-renal or juxta-renal aneurysms. A multitude of new devices are now being investigated for use in the US to treat complex aneurysm morphology. Many of these devices are already being used internationally. Cook Medical has developed three additional devices designed to treat visceral segment aneurysms and to maintain hypogastric patency. Most notable is the Zenith® t-Branch™, which is capable of treating thoracoabdominal aortic aneurysms. Gore Medical (Flagstaff, AZ), has also developed two new devices, a thoracic branch device to maintain left subclavian artery patency and an iliac branch device. Medtronic (Minneapolis, MN) has also developed a thoracic branch device. Kawasumi laboratories (Tokyo, Japan) have also pioneered an endograft capable of treating aortic arch aneurysms. The feasibility of treating aneurysms along the entire aortic length is rapidly becoming a reality. Preliminary data on these new devices demonstrate excellent technical success with acceptable morbidity and mortality rates.

Authors:

Rami O. Tadros, MD, Assistant Professor of Surgery and Radiology, Associate Program Director , Department of Surgery, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York , Peter L. Faries, MD, Professor of Surgery and Radiology, Chief of Vascular Surgery , Department of Surgery, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York , Windsor Ting, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York , Sharif H. Ellozy, MD, Associate Professor of Surgery and Radiology , Department of Surgery, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York , Michael L. Marin, MD, Professor of Surgery and Radiology, Chairman of Surgery , Department of Surgery, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York

PMID:  24700229

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