OBJECTIVES: Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports 'real-world' early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS: All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/- root +/- arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS: The median age was 58 years [interquartile range (IQR) 46-70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3-4+ in 37 (79%) patients. Forty-one (87%) patients had zero-trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5-20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10-13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS: Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.
OBJECTIVES:Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports 'real-world' early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS: All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/- root +/- arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS: The median age was 58 years [interquartile range (IQR) 46-70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3-4+ in 37 (79%) patients. Forty-one (87%) patients had zero-trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5-20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10-13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS: Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.
Authors: Domenico Mazzitelli; Theodor Fischlein; J Scott Rankin; Yeong-Hoon Choi; Christof Stamm; Steffen Pfeiffer; Jan Pirk; Christian Detter; Johannes Kroll; Friedhelm Beyersdorf; Charles D Griffin; Malakh Shrestha; Christian Nöbauer; Philip S Crooke; Christian Schreiber; Rüdiger Lange Journal: Eur J Cardiothorac Surg Date: 2015-07-08 Impact factor: 4.191
Authors: David N Ranney; Babatunde A Yerokun; Ehsan Benrashid; Muath Bishawi; Adam Williams; Richard L McCann; G Chad Hughes Journal: Ann Thorac Surg Date: 2018-08-23 Impact factor: 4.330
Authors: Brian Lima; Judson B Williams; S Dave Bhattacharya; Asad A Shah; Nicholas Andersen; Andrew Wang; J Kevin Harrison; G Chad Hughes Journal: J Heart Valve Dis Date: 2011-07
Authors: Domenico Mazzitelli; Christian Nöbauer; J Scott Rankin; Catalin C Badiu; Magdalena Dorfmeister; Philip S Crooke; Anke Wagner; Christian Schreiber; Rüdiger Lange Journal: Eur J Cardiothorac Surg Date: 2013-08-19 Impact factor: 4.191
Authors: Domenico Mazzitelli; Christof Stamm; J Scott Rankin; Steffen Pfeiffer; Theodor Fischlein; Jan Pirk; Yeong-Hoon Choi; Christian Detter; Johannes Kroll; Friedhelm Beyersdorf; Malakh Shrestha; Christian Schreiber; Rüdiger Lange Journal: Ann Thorac Surg Date: 2014-12-01 Impact factor: 4.330
Authors: Asvin M Ganapathi; Brian R Englum; Jennifer M Hanna; Matthew A Schechter; Jeffrey G Gaca; Lynne M Hurwitz; G Chad Hughes Journal: J Thorac Cardiovasc Surg Date: 2013-10-30 Impact factor: 5.209