CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 AFRICA 143 Results The mean age of this cohort was 56.3 ± 14.3 years (24–79) and the majority were men (75%). Sixteen (33.5%) of the patients were obese and five of these patients were morbidly obese. Five (10.41%) of the 48 patients had ATAAD, four (8.3%) had Marfan syndrome and five (10.41%) had bicuspid aortic valve (BAV). The mean aortic root diameter was 5.1 ± 0.6 cm (3.7–6.8) and the mean diameter for the assending aorta was 5.4 ± 2.1 cm (3.4–8.1). Forty-six patients (95%) had at least moderate AR. Two of the patients with BAV had grade 4+ AI, two had grade 3+ AI and one had grade 1+ AI. Twenty-eight patients (58.3%) had symptoms graded as New York Heart Association (NYHA) class II or higher. Table 1 summarises the pre-operative data of these patients. In 28 (58.3%) of the 48 patients, the isolated modified David V technique was performed. In 20 (41.7%) of the patients, the modified David V and additional surgical procedures were performed simultaneously. Mean aortic cross-clamp time and CPB time were 165 ± 35 minutes (100–227) and 205 ± 30 minutes (135–420), respectively. The mean proximal and distal graft sizes were 33.4 ± 0.9 mm (30–34) and 29.4 ± 1.1 mm (26–32), respectively. Inpre-operative echocardiography, > grade 2mitral insufficieny was detected in six patients and concomitant mitral valve repair was performed. In pre-operative screening, coronary artery disease was seen in 11 patients and complete revascularisation was performed concomitantly. Three patients needed additional leaflet repair to the aortic cusps because the non-coronary cusp of the aortic valve was prolapsing. Free margin plication was performed in one patient and free margin resuspension was performed in the other two patients. In five patients (10.54%) with BAV, no additional leaflet repair was required on the aortic valves and only the David V re-implantation technique was performed. Two patients had atrial fibrillation in the pre-operative screening and concomitant surgical ablation was performed. In one patient with aortic dissection, the dissection flap reached the aortic arch. Total arch replacement and the David V were performed concomitantly. One patient had secundum type atrial septal defect (ASD) with a 1-cm diameter. ASD repair and the David V technique were performed concomitantly. Table 2 describes the operative data. Two (4.2%) of the elective patients died in the early postoperative period. The first was a 76-year-old patient with a hypertrophic left ventricle.Low-cardiac-output syndromeoccured in the early postoperative period, from which the patient did not Table 1. Pre-operative data (n = 48) Characteristics Results Gender (male) 36 (75) Age (years) 56.3 ± 14.3 (24–79) BMI (kg/m2) 28.4± 5.2 (18–46) Associated diseases Hypertension 31 (64.6) Diabetes mellitus 10 (20.8) COPD 14 (29.2) CAD 11 (20.8) Renal insufficiency 5 (10.4) Marfan syndrome 4 (8.3) BAV 5 (10.4) Electrocardiography Sinus rythm 46 (95.8) Ascending aorta pathological condition ATAAD 5 (10.4) Aneurysm without dissection 43 (89.5) Echocardiographic values LVEF (%) 59.2 ± 9.7 (30–65) LVESD (cm) 3.7 ± 0.9 (2.6–6.3) LVEDD (cm) 5.5 ± 0.9 (4.2–7.6) LVH 5 (10.5) BAV 5 (10.4) Aortic insufficiency, n (%) 0 (trace, or trivial) 1 (2.1) 1+ (mild) 1 (2.1) 2+ (moderate) 21 (43.8) 3+ (moderately severe) 17 (35.4) 4+ (severe) 8 (16.7) Diameters (cm ± SD) Aortic annulus 2.9 ± 0.4 (1.9–4) Sinus of Valsalva 5.1 ± 0.6 (3.7–6.8) STJ 5.2 ± 0.7 (3.7–8) Ascending aorta 5.4 ± 2.1 (3.4–8.1) NYHA classification Class I 20 (41.6) Class II 18 (37.5) Class III 4 (8.3) Class IV 6 (12.5) Previous sternotomy 0 Values are presented as mean ± standard deviation or frequencies (%). BMI: body mass index, COPD: chronic obstructive pulmonary disease, CAD: coronary artery disease, LVEF: left ventricular ejection fraction, LVESD: left ventricular end-systolic diameter, LVEDD: left ventricular end-diastolic diameter, LVH: left ventricular hypertrophy, BAV: bicuspid aortic valve, STJ: sinotubular junction, ATAAD: acute type A aortic dissection; NYHA: New York Heart Association. Table 2. Operative data Operation type Number ACCT (min) CPBT (min) Isolated mDav V 28 (58.3) 157 ± 26 (120–221) 210 ± 57 (152–420) mDav V + extra leaflet repair 3 (6.3) 162 ± 31 (158–169) 192 ± 9 (181– 201) mDav V + aortic arch replacement 1 (2.1) 180 230 mDav V + MVRx 3 (6.3) 164 ± 34 (160–171) 195 ± 10 (184–205) mDav V + MVRx + ablation 1 (2.1) 127 193 mDav V + CABG + ablation 1 (2.1) 145 180 mDav V + MVRx + CABG 2 (4.2) 207 ± 38 (180–234) 251 ± 29 (230–272) mDav V + CABG 8 (16.7) 176 ± 42 (100–227) 213 ± 47 (135–286) mDav V + ASD repair 1 (2.1) 160 180 Total 48 165 ± 35 (100–227) 205 ± 30 (135–420) Graft diamaters (mm ± SD ) Proximal graft 33.4 ± 0.9 (30–34) Distal graft 29.4 ± 1.1 (26–32) Hypothermic circulatory arrest used 1 (2) Circulatory arrest time, min 25 With antegrade cerebral perfusion 1 (2) Antegrade cerebral perfusion time, min 24 Values are presented as mean ± standard deviation or n (%). ASD: atrial septal defect, ACCT: aortic cross-clamping time, CABG: coronary artery bypass graft, CPBT: cardiopulmonary bypass time, mDav V: modified David V procedure, MVRx: mitral valve repair, SD: standard deviation.
RkJQdWJsaXNoZXIy NDIzNzc=