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Florida Sleeve is a Safe and Effective Technique for Valve Salvage in Acute Stanford Type A Aortic Dissection
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  • Mahmoud Alhussaini ,
  • Eric Jeng,
  • Tomas Martin,
  • Amber Filion,
  • Thomas Beaver,
  • George Arnaoutakis
Mahmoud Alhussaini
University of Florida
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Eric Jeng
University of Florida
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Tomas Martin
University of Florida
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Amber Filion
University of Florida
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Thomas Beaver
University of Florida
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George Arnaoutakis
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Abstract

Objective: Valve-sparing root replacement is commonly used for management of aortic root aneurysms in elective setting, but its technical complexity hinders its broader adoption for acute Type-A Aortic Dissection (ATAAD). The Florida Sleeve (FS) procedure is a simplified form of valve sparing aortic root reconstruction that does not require coronary reimplantation. Here, we present our outcomes of the Florida Sleeve (FS) repair in patients with dilated roots in the setting of an ATAAD. Methods: We retrospectively reviewed 24 consecutive patients (2002-2018) treated with FS procedure for ATAAD. Demographic, operative, and postoperative outcomes were queried from our institutional database. Long term follow-up was obtained from clinic visits for local patients, and with telephone and telehealth measures otherwise. Results: Mean age was 49 ± 14 years with 19 (79%) males. Marfan syndrome was present in 4 (16.7%) patients and 14 (58.3) had ≥2+ aortic insufficiency (AI). Nine (37.2%) had preoperative mal-perfusion or shock. The FS was combined with hemi-arch replacement in 15 (62.5%) patients and a zone-2 arch replacement in 9 (37.5%) patients. There were 2 (8.3%) early postoperative mortalities. Median follow-up period was 46 months (range; 0.3-146). The median survival of the entire cohort was 143.4 months. One patient (4.2%) required redo aortic valve replacement for unrelated aortic valve endocarditis at 30 months postoperatively. Conclusion: FS is simplified and reproducible valve-sparing root repair. In appropriate patients, it can be applied safely in acute Stanford type-A aortic dissection with excellent early and long-term results.

Peer review status:Published

06 Sep 2021Submitted to Journal of Cardiac Surgery
06 Sep 2021Submission Checks Completed
06 Sep 2021Assigned to Editor
06 Sep 2021Reviewer(s) Assigned
13 Sep 2021Review(s) Completed, Editorial Evaluation Pending
13 Sep 2021Editorial Decision: Revise Minor
02 Oct 20211st Revision Received
06 Oct 2021Submission Checks Completed
06 Oct 2021Assigned to Editor
06 Oct 2021Reviewer(s) Assigned
07 Oct 2021Review(s) Completed, Editorial Evaluation Pending
07 Oct 2021Editorial Decision: Accept
Jan 2022Published in Journal of Cardiac Surgery volume 37 issue 1 on pages 39-46. 10.1111/jocs.16078