J Scott Rankin, Domenico Mazzitelli1, Theodor Fischlein2, Yeong-Hoon Choi3, Jan Pirk4, Steffen Pfeiffer2, Lawrence M Wei, Vinay Badhwar. 1. Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Germany. 2. Department of Cardiovascular Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany. 3. Department of Cardiac and Thoracic Surgery, University of Köln, Köln, Germany. 4. Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Abstract
OBJECTIVE: An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms. METHODS: Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection. Valve repair was performed using trileaflet (n = 40) or bicuspid (n = 7) internal geometric rings, together with leaflet reconstruction. Ascending aortic and/or remodeling root replacements were accomplished with Dacron grafts 5 to 7 mm larger than the rings. An Echo Core Lab provided independent echocardiographic assessments, and changes over time were evaluated by Friedman tests. RESULTS: Mean ± SD age was 60 ± 14 years, 57% (27/47) were male, 15% (7/47) had bicuspid valves, 87% (41/47) had moderate-to-severe aortic insufficiency, and 13% (6/47) had mild aortic insufficiency. All patients had annular dilatation, with a mean ± SD of 26.5 ± 2.6 mm before repair, and mean ± SD ring sizes were 21.7 ± 1.7 mm. Follow-up was 42 months (mean = 27 months). No operative mortality or valve-related complications occurred. Two patients died beyond 1 year from nonvalve-related causes. One patient required valve replacement for repair failure. Survival free of complications or valve replacement was 94% at 2 years. Significant reduction in aortic insufficiency and New York Heart Association class were observed (P < 0.0001), and valve gradients remained low. No heart block or direct ring complications occurred. CONCLUSIONS: In preliminary regulatory studies, aortic ring annuloplasty seemed safe and effective during aortic aneurysm surgery. This approach could help standardize aortic valve repair.
OBJECTIVE: An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms. METHODS: Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection. Valve repair was performed using trileaflet (n = 40) or bicuspid (n = 7) internal geometric rings, together with leaflet reconstruction. Ascending aortic and/or remodeling root replacements were accomplished with Dacron grafts 5 to 7 mm larger than the rings. An Echo Core Lab provided independent echocardiographic assessments, and changes over time were evaluated by Friedman tests. RESULTS: Mean ± SD age was 60 ± 14 years, 57% (27/47) were male, 15% (7/47) had bicuspid valves, 87% (41/47) had moderate-to-severe aortic insufficiency, and 13% (6/47) had mild aortic insufficiency. All patients had annular dilatation, with a mean ± SD of 26.5 ± 2.6 mm before repair, and mean ± SD ring sizes were 21.7 ± 1.7 mm. Follow-up was 42 months (mean = 27 months). No operative mortality or valve-related complications occurred. Two patients died beyond 1 year from nonvalve-related causes. One patient required valve replacement for repair failure. Survival free of complications or valve replacement was 94% at 2 years. Significant reduction in aortic insufficiency and New York Heart Association class were observed (P < 0.0001), and valve gradients remained low. No heart block or direct ring complications occurred. CONCLUSIONS: In preliminary regulatory studies, aortic ring annuloplasty seemed safe and effective during aortic aneurysm surgery. This approach could help standardize aortic valve repair.
Authors: Oliver K Jawitz; Vignesh Raman; Jatin Anand; Muath Bishawi; Soraya L Voigt; Julie Doberne; Andrew M Vekstein; E Hope Weissler; Joseph W Turek; G Chad Hughes Journal: Eur J Cardiothorac Surg Date: 2020-06-01 Impact factor: 4.191
Authors: Radosław Gocoł; Marek Jasiński; Damian Hudziak; Jarosław Bis; Aleksandra Żak; Piotr Duraj; Magdalena Mizia; J Scott Rankin; Marek A Deja Journal: Cardiol J Date: 2019 Impact factor: 2.737
Authors: Marc W Gerdisch; T Brett Reece; Dominic Emerson; Richard S Downey; Geoffrey B Blossom; Arun Singhal; Joshua N Baker; Theodor J M Fischlein; Vinay Badhwar Journal: JTCVS Tech Date: 2022-06-09
Authors: J Scott Rankin; Domenico Mazzitelli; Theodor J M Fischlein; Yeong-Hoon Choi; Diana Aicher; Lawrence M Wei; Vinay Badhwar Journal: JTCVS Tech Date: 2020-01-23