Aortic Valve Repair Using Geometric Ring Annuloplasty

Abstract

AVr has steadily progressed since initial efforts by Cabrol,33Cabrol A Guiraudon G Bertrand M. Le traitement de l'insuffisance aortique par l'annuloplastie aortique.Arch des Mal du Coeur. 1966; 59: 1305-1312PubMed Google Scholar Carpentier,15Carpentier A. Cardiac valve surgery—the "French correction".J Thorac Cardiovasc Surg. 1983; 86: 323-337Abstract Full Text PDF PubMed Google Scholar Cosgrove,34Cosgrove DM Rosenkranz ERH Hendren WG et al.Valvuloplasty for aortic insufficiency.J Thorac Cardiovasc Surg. 1991; 102: 571-577Abstract Full Text PDF PubMed Google Scholar and Duran.27Duran C Kumar N Gometza B et al.Indications and limitations of aortic valve reconstruction.Ann Thorac Surg. 1991; 52: 447-454Abstract Full Text PDF PubMed Scopus (102) Google Scholar The innovation of central leaflet plication by Schäfers and associates24Langer F Graeter T Nikoloudakis N et al.Valve-preserving aortic replacement: Does the additional repair of leaflet prolapse adversely affect the results?.J Thorac Cardiovasc Surg. 2001; 122: 270-277Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar,25Schaefers H-J Aicher D Langer F. Correction of leaflet prolapse in valve-preserving aortic replacement: Pushing the limits?.Ann Thorac Surg. 2002; 74: 1762-1764Abstract Full Text Full Text PDF Scopus (68) Google Scholar was a key advance, since leaflet prolapse is a prominent feature of AI. Annuloplasty also is important during AVr, and following Carpentier's concept, geometric annuloplasty rings were developed for placement into the inflow aspect of the aortic valve annulus.11Rankin JS Mazzitelli D Fischlein TJM et al.Geometric ring annuloplasty for aortic valve repair during aortic aneurysm surgery: Two-year clinical trial results.Innovations. 2018; 13: 248-253Crossref PubMed Scopus (28) Google Scholar,12Rankin JS Mazzitelli D Fischlein TJM et al.Bicuspid aortic valve repair using geometric ring annuloplasty: A first-in-humans pilot trial.JTCVS Tech. 2020; 1: 18-25Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar After over 1000 clinical ring implants, techniques of AVr together with leaflet reconstruction have allowed successful repair of 40 different AI valve etiologies (Table 1) and over 90% of AI cases encountered. Longer-term follow-up of aortic ring annuloplasty now shows 8-year Kaplan-Meier survival and freedom from reoperation exceeding 80%.35Baker JN Klokocovnik T Miceli A et al.Minimally invasive aortic valve repair using geometric ring annuloplasty.Ann Surg. 2021; (Submitted for publication)PubMed Google Scholar These results are consistent with other important late AVr follow-up studies,6Miyahara S Schneider U Marganthaler L et al.Almost) all nonstenotic bicuspid aortic valves should be preserved or repaired.Sem Thoracic Surg. 2019; 31: 656-660Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,36Schneider U Hofmann C Schope J et al.Long-term results of differentiated anatomic reconstruction of bicuspid aortic valves.JAMA Cardiol. 2020; (In press)https://doi.org/10.1001/jamacardio.2020.3749Crossref Scopus (25) Google Scholar although further experience and analysis will be required for full validation.Table 1Etiologies of AI Repaired With Geometric Ring Annuloplasty in over 1000 Clinical CasesA. Primary annular dilatation with leaflet defects (no aneurysm)1. Pure annular dilatation2. Isolated leaflet prolapse3. Ruptured leaflet fenestrations4. Extensive leaflet fenestrations5. Traumatic commissural/leaflet rupture6. Release of retracted leaflet Noduli7. Rheumatic aortic insufficiency8. Healed endocarditisB. Aneurysms9. Ascending aortic aneurysms with AI10. Tri-leaflet aortic root aneurysms with AI11. Syndromic aneurysms12. Aortic root dissections13. Complex arch aneurysms with AI14. Sinus of Valsalva aneurysm with AI15. Tri-leaflet and bicuspid root aneurysms with anomalous coronary arteriesC. AI with concomitant procedures16. Multiple valve disease—degenerative, Marfan, rheumatic17. Coronary artery bypass with AI18. Destination VAD with AID. Selected aortic stenosis19. Unicuspid valves with AS/AI and limited calcification20. Highly selected calcific aortic stenosis in bicuspid and tri-leaflet valvesE. Revision of previous valve-sparing surgery21. Failed Yacoub procedure22. Failed David reimplantation23. Failed subcommissural annuloplasty24. Failed commissural resuspension for dissectionF. Bicuspid aortic valve (BAV) defects25. Sievers Type 0 BAV insufficiency26. Sievers Type 1 BAV insufficiency27. Sievers Type 2 (unicuspid) BAV insufficiency28. BAV associated with ascending aortic and/or root aneurysms29. Variant BAV defects30. BAV repair after previous balloon valvuloplasty31. Repair of diminutive BAVG. Complex congenital defects32. VSD with AI33. LVOT membrane with AI34. Dilated ross autograft with AI35. TGA S/P arterial switch with AI/neoroot aneurysm36. Congenital aortic root aneurysm37. Truncus valves with AI38. Quadricuspid valves with AI39. Hypoplastic left heart syndrome, S/P Norwood procedure40. L-transposition S/P Fontan procedure with scarred-retracted aortic valve leaflet Open table in a new tab

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