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. 2019 Apr;7(2):49-55.
doi: 10.1055/s-0039-1687854. Epub 2019 Sep 17.

The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Seyed Hossein Aalaei-Andabili  1   2 , Tomas D Martin  1 , Philip J Hess  3 , Ashkan Karimi  2 , Anthony A Bavry  2   4 , George J Arnaoutakis  1 , Thomas M Beaver  1
Affiliations

The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Seyed Hossein Aalaei-Andabili et al. Aorta (Stamford). 2019 Apr.

Abstract

Background: The Florida (FL) Sleeve procedure was introduced as a simplified approach for valve-sparing correction of functional Type I aortic insufficiency (AI) associated with aortic root aneurysms. In this study, short- and long-term outcomes after the FL Sleeve procedure were investigated.

Methods: From May 2002 to January 2016, 177 patients underwent the FL Sleeve procedure. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter, left ventricular ejection fraction, and degree of AI (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4) were evaluated by echocardiography.

Results: Mean ± standard deviation of age was 49.41 ± 15.37 years. Survival rate was 98% at 1 year, 97% at 5 years, and 93% at 8 years. Freedom from reoperation was 99% at 1 year and 98% at 2 to 8 years. Three patients (1.69%) died during hospitalization. Three patients (1.69%) developed periprocedural stroke. Postoperative follow-up echocardiography was available in 140 patients at 30 days, and 31 patients at 5 years. AI grade significantly improved from baseline at 30 days (2.18 ± 1.26 vs. 1.1 ± 0.93, p < 0.001) and at 5 years (2.0 ± 1.23 vs. 1.45 ± 0.88, p = 0.04). Preoperative mean LVEDD significantly decreased from 52.20 ± 6.73 to 46.87 ± 8.40 (p < 0.001) at 30 days, and from 53.22 ± 7.07 to 46.61 ± 10.51 (p = 0.01) at 5 years.

Conclusions: The FL Sleeve procedure is a safe, effective, and durable treatment of aortic root aneurysm and Type I AI. Long-term survival and freedom from reoperation rates are encouraging.

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Conflict of interest statement

The authors declare no conflict of interest related to this article.

Figures

Fig. 1
Fig. 1
The four subannular anchoring sutures are placed in the same horizontal plane, 2 to 3 mm below the lowest point of the center of the leaflets; three are in line with the commissures, and the fourth is placed under the noncoronary cusp. The left coronary artery keyhole is cut after the sleeve is temporarily seated. The slits in the graft below the coronary keyholes are repaired after the sleeve is seated.
Fig. 2
Fig. 2
The running horizontal mattress suture both suspends the aorta and orients the posts of the commissures. Redundant aortic wall at the sinotubular junction should be imbricated with small pleats using multiple, closely spaced bites of the running anastomotic suture.
Fig. 3
Fig. 3
Completed repair.
Fig. 4
Fig. 4
Patients' survival and freedom from reoperation rates after the Florida Sleeve procedure.
See this image and copyright information in PMC

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