Florida sleeve repair for aortic insufficiency: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Dongliang , LIU Shengchen ,  HUANG Fuhua

Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P. R. China;

Corresponding?author：

HUANG Fuhua, Email: huangfuhua@sina.cn

Keywords：

Valve-sparing aortic root replacement; aortic insufficiency; Florida sleeve procedure; aortic valvuloplasty

DOI：

10.7507/1007-4848.202407024

Video：

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Objective To analyze the early prognosis of repairing adult aortic insufficiency with the Florida sleeve procedure. Methods The patients with aortic insufficiency who underwent Florida sleeve repair in the Nanjing First Hospital, Nanjing Medical University between August 2020 and May 2024 were selected. Their general data, perioperative conditions, and echocardiographic data before, during, and after the procedure and at follow-up were analyzed. Results Fifteen patients were included, consisting of 12 males and 3 females, aged 33-71 (53.5±12.4) years. Preoperative echocardiography indicated that there was 1 patient of rheumatic disease, 7 patients of degenerative disease, 4 patients secondary to aortic aneurysm, and 3 patients of bicuspid aortic valve. The severity distribution included 2 patients of severe insufficiency, 4 patients of moderate-to-severe insufficiency, 5 patients of moderate insufficiency, and 4 patients of mild-to-moderate insufficiency. The mean cardiopulmonary bypass time was (135.0±40.0) minutes, the aortic cross-clamp time was (109.9±38.6) minutes, and the median ICU stay was 1.0 day. No mortality was recorded within 30 days postoperatively. Follow-up echocardiography showed that the valve regurgitation, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and sinus diameter all achieved the desired outcomes. Conclusion Florida sleeve repair for aortic valve in patients with a sinus diameter less than 50 mm not only effectively improves hemodynamics in adults with aortic insufficiency, but also has the advantages of low surgical risk and rapid postoperative recovery, making it a promising procedure for clinical application.

Citation： CHEN Dongliang, LIU Shengchen, HUANG Fuhua. Florida sleeve repair for aortic insufficiency: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(4): 521-526. doi: 10.7507/1007-4848.202407024 Copy

1.	張玉璽, 馮樂樂, 陳城, 等. 主動脈瓣修復手術早中期結果及術后關閉不全的風險因素評估. 中國體外循環雜志, 2022, 20(2): 86-91.Zhang YX, Feng LL, Chen C, et al. Short and medium term outcomes and predictors of recurrent aortic regurgitation after aortic valve repair. Chin J ECC, 2022, 20(2): 86-91.
2.	宋磊, 趙雪松, 楊新衛. 主動脈瓣關閉不全治療的研究進展. 中西醫結合心腦血管病雜志, 2023, 21(12): 2218-2221.Song L, Zhao XS, Yang XW. Research progress in the treatment of aortic insufficiency. Chin J Integr Med Cardio-Cerebrovasc Dis, 2023, 21(12): 2218-2221.
3.	左煜, 黃強. 成人主動脈瓣關閉不全行主動脈瓣成形術研究現狀. 心肺血管病雜志, 2022, 41(2): 206-209.Zuo Y, Huang Q. Current status of aortic valvuloplasty in adults with aortic insufficiency. J Cardiovasc Pulmon Dis, 2022, 41(2): 206-209.
4.	Furukawa K, Ohteki H, Cao ZL, et al. Does dilatation of the sinotubular junction cause aortic regurgitation? Ann Thorac Med, 1999, 68(3): 949-953.
5.	Roman MJ. Aortic root dilatation as a cause of isolated, severe aortic regurgitation. Ann Intern Med, 1987, 106(6): 800.
6.	侯倩文, 劉桂梅, 劉寧, 等. 主動脈根部擴張情況下竇部直徑對瓣膜開閉性能的影響. 生物醫學工程學雜志, 2019, 36(5): 737-744.Hou QW, Liu GM, Liu N, et al. Effect of sinus diameter on the opening and closing performance of aortic valve under the expansion of aortic root. J Biomed Eng, 2019, 36(5): 737-744.
7.	Katayama S, Umetani N, Sugiura S, et al. The sinus of valsalva relieves abnormal stress on aortic valve leaflets by facilitating smooth closure. J Thorac Cardiovasc Surg, 2008, 136(6): 1528-1535. e1.
8.	Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: A new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750.
9.	孫立忠, 田良鑫, 常謙, 等. 保留主動脈瓣的主動脈根部替換術(David手術). 中華醫學雜志, 2003, 83(9): 803-804.Sun LZ, Tian LX, Chang Q et al. Aortic root replacement with aortic valve retention (David operation). Natl Med J China, 2003, 83(9): 103-104.
10.	David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg, 1992, 103(4): 617-621.
11.	Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090.
12.	Aalaei-Andabili SH, Martin TD, Hess PJ, et al. The Florida sleeve procedure is durable and improves aortic valve function. Aorta (Stamford), 2019, 7(2): 49-55.
13.	Freeman KA, Arnaoutakis GJ, Jeng EI, et al. Florida sleeve operative technique. Oper Tech Thorac Cardiovasc Surg, 2021, 26(2): 306-321.
14.	王世杰, 劉鵬, 溫姝鈺, 等. 主動脈瓣疾病手術治療現狀與進展. 臨床心血管病雜志, 2023, 39(6): 417-424.Wang SJ, Liu P, Wen SY, et al. Current status and progress of aortic valve surgery treatment. J Clin Cardiol, 2023, 39(6): 417-424.
15.	潘蓀, 王春生. PERIGON研究5年隨訪結果解讀及外科主動脈瓣生物瓣置換的思考. 中國胸心血管外科臨床雜志, 2023, 30(1): 17-24.Pan S, Wang CS, et al. Implications of five-year outcomes of PERIGON trial for bioprosthetic aortic valve replacement. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(1): 17-24.
16.	陸方林, 孫寒松, 徐學增, 等. 開拓進取譜華章—我國瓣膜性心臟病事業的發展與成就. 中國心血管病研究, 2021, 19(11): 961-965.Lu FL, Sun HS, Xu XZ, et al. The development and achievements of valvular heart disease in China. Chin J Cardiovasc Res, 2021, 19(11): 961-965.
17.	Hess PJ, Harman PK, Klodell CT, et al. Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms. Ann Thorac Surg, 2009, 87(4): 1161-1169.
18.	Gamba A, Tasca G, Giannico F, et al. Early and medium term results of the sleeve valve-sparing procedure for aortic root ectasia. Ann Thorac Surg, 2015, 99(4): 1228-1233.
19.	Tasca G, Selmi M, Votta E, et al. Aortic root biomechanics after sleeve and david sparing techniques: A finite element analysis. Ann Thorac Surg, 2017, 103(5): 1451-1459.
20.	Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2011, 41(1): 56-61.

1. 張玉璽, 馮樂樂, 陳城, 等. 主動脈瓣修復手術早中期結果及術后關閉不全的風險因素評估. 中國體外循環雜志, 2022, 20(2): 86-91.Zhang YX, Feng LL, Chen C, et al. Short and medium term outcomes and predictors of recurrent aortic regurgitation after aortic valve repair. Chin J ECC, 2022, 20(2): 86-91.
2. 宋磊, 趙雪松, 楊新衛. 主動脈瓣關閉不全治療的研究進展. 中西醫結合心腦血管病雜志, 2023, 21(12): 2218-2221.Song L, Zhao XS, Yang XW. Research progress in the treatment of aortic insufficiency. Chin J Integr Med Cardio-Cerebrovasc Dis, 2023, 21(12): 2218-2221.
3. 左煜, 黃強. 成人主動脈瓣關閉不全行主動脈瓣成形術研究現狀. 心肺血管病雜志, 2022, 41(2): 206-209.Zuo Y, Huang Q. Current status of aortic valvuloplasty in adults with aortic insufficiency. J Cardiovasc Pulmon Dis, 2022, 41(2): 206-209.
4. Furukawa K, Ohteki H, Cao ZL, et al. Does dilatation of the sinotubular junction cause aortic regurgitation? Ann Thorac Med, 1999, 68(3): 949-953.
5. Roman MJ. Aortic root dilatation as a cause of isolated, severe aortic regurgitation. Ann Intern Med, 1987, 106(6): 800.
6. 侯倩文, 劉桂梅, 劉寧, 等. 主動脈根部擴張情況下竇部直徑對瓣膜開閉性能的影響. 生物醫學工程學雜志, 2019, 36(5): 737-744.Hou QW, Liu GM, Liu N, et al. Effect of sinus diameter on the opening and closing performance of aortic valve under the expansion of aortic root. J Biomed Eng, 2019, 36(5): 737-744.
7. Katayama S, Umetani N, Sugiura S, et al. The sinus of valsalva relieves abnormal stress on aortic valve leaflets by facilitating smooth closure. J Thorac Cardiovasc Surg, 2008, 136(6): 1528-1535. e1.
8. Hess PJ, Klodell CT, Beaver TM, et al. The Florida sleeve: A new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg, 2005, 80(2): 748-750.
9. 孫立忠, 田良鑫, 常謙, 等. 保留主動脈瓣的主動脈根部替換術(David手術). 中華醫學雜志, 2003, 83(9): 803-804.Sun LZ, Tian LX, Chang Q et al. Aortic root replacement with aortic valve retention (David operation). Natl Med J China, 2003, 83(9): 103-104.
10. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg, 1992, 103(4): 617-621.
11. Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090.
12. Aalaei-Andabili SH, Martin TD, Hess PJ, et al. The Florida sleeve procedure is durable and improves aortic valve function. Aorta (Stamford), 2019, 7(2): 49-55.
13. Freeman KA, Arnaoutakis GJ, Jeng EI, et al. Florida sleeve operative technique. Oper Tech Thorac Cardiovasc Surg, 2021, 26(2): 306-321.
14. 王世杰, 劉鵬, 溫姝鈺, 等. 主動脈瓣疾病手術治療現狀與進展. 臨床心血管病雜志, 2023, 39(6): 417-424.Wang SJ, Liu P, Wen SY, et al. Current status and progress of aortic valve surgery treatment. J Clin Cardiol, 2023, 39(6): 417-424.
15. 潘蓀, 王春生. PERIGON研究5年隨訪結果解讀及外科主動脈瓣生物瓣置換的思考. 中國胸心血管外科臨床雜志, 2023, 30(1): 17-24.Pan S, Wang CS, et al. Implications of five-year outcomes of PERIGON trial for bioprosthetic aortic valve replacement. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(1): 17-24.
16. 陸方林, 孫寒松, 徐學增, 等. 開拓進取譜華章—我國瓣膜性心臟病事業的發展與成就. 中國心血管病研究, 2021, 19(11): 961-965.Lu FL, Sun HS, Xu XZ, et al. The development and achievements of valvular heart disease in China. Chin J Cardiovasc Res, 2021, 19(11): 961-965.
17. Hess PJ, Harman PK, Klodell CT, et al. Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms. Ann Thorac Surg, 2009, 87(4): 1161-1169.
18. Gamba A, Tasca G, Giannico F, et al. Early and medium term results of the sleeve valve-sparing procedure for aortic root ectasia. Ann Thorac Surg, 2015, 99(4): 1228-1233.
19. Tasca G, Selmi M, Votta E, et al. Aortic root biomechanics after sleeve and david sparing techniques: A finite element analysis. Ann Thorac Surg, 2017, 103(5): 1451-1459.
20. Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2011, 41(1): 56-61.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Florida sleeve repair for aortic insufficiency: A retrospective study in a single center

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