A modern approach to aortic valve insufficiency: Aortic root restoration via HAART 300 internal annuloplasty ring

Abstract

Background and Aim of the Study HAART 300 is an internal geometric annuloplasty ring. The safety and efficacy of this novel device in aortic valve (AV) repair in a single referral center are reported. Methods Twenty patients with trileaflet AV insufficiency with ascending aorta and/or aortic root enlargement were included. Subannular implantation was performed to correct annular dilatation, whereas concomitant leaflet repair was performed whenever required. All but two patients also received ascending aorta replacement, whereas selective sinus replacement was performed in all but five patients. Results Follow‐up was for a maximum of 3.8 years and a mean of 2.2 years. Mean age was 54.2 years old. Moderate to severe preoperative AV insufficiency was noted in 75% of patients, whereas 70% of them had an ascending aorta over 45 mm. One patient was lost from follow‐up. Overall mortality as well as major complication rates were zero. Early postoperatively, no more than mild AV regurgitation was detected, whereas only one patient appeared with moderate AV regurgitation during our 2.2‐year follow‐up. New York Heart Association class was also significantly lower compared to preoperative values and valve gradients remained low at last follow‐up. Conclusions Geometric ring annuloplasty is a safe and effective valve sparing approach to deal with AV insufficiency contributing to overall root reconstruction. Short‐term results are excellent rendering this easily reproducible and versatile method very attractive.

Four-Dimensional Magnetic Resonance after Ascending Aorta Replacement and Aortic Valve Repair with HAART 300 Internal Annuloplasty Ring

“…In patients with aortic insufficiency (AI), preserving the native aortic valve (AV) through valve repair has been shown to reduce valve-related complications and improve survival compared to surgical AV replacement 1 . Valve-sparing aortic root replacement (VSARR) also carries similar to improved morbidity and mortality compared to valve-replacing root replacement; therefore, improving valve repair techniques is of significant interest 2 .…”

Aortic Valve Repair: The Evolving Frontiers of Aortic Annuloplasty

“…3 Although early results with this internal rigid annuloplasty ring have been promising, its ultimate safety, efficacy, and durability in the medium-and long-term remain to be determined. 3,12,17 This device can facilitate the restoration of a native elliptical annular shape, with the reinforcement of the ventriculoaortic junction as part of a multimodal approach to aortic valve repair that considers the components of the functional aortic annulus for each given aortic phenotype. 17 This internal annuloplasty ring offers calibrated reproducibility for basal subvalvular annuloplasty in aortic valve repair that will encourage dissemination of this technique as aortic valve repair enters the mainstream of cardiac surgical practice.…”

“…3,12,17 This device can facilitate the restoration of a native elliptical annular shape, with the reinforcement of the ventriculoaortic junction as part of a multimodal approach to aortic valve repair that considers the components of the functional aortic annulus for each given aortic phenotype. 17 This internal annuloplasty ring offers calibrated reproducibility for basal subvalvular annuloplasty in aortic valve repair that will encourage dissemination of this technique as aortic valve repair enters the mainstream of cardiac surgical practice. Further future hardware refinements likely will amplify its applicability and utility.…”

Solid aortic annuloplasty opening up for new valve sparing options

“…We have read with great interest the article by Papakonstantinou et al 1 providing a single‐center analysis of the contemporary approach to tricuspid aortic valve (TAV) insufficiency with the use of HAART 300 annuloplasty ring. The study included 20 patients, 75% of whom presented with moderate to severe aortic valve insufficiency and 70% had dilated ascending aorta (above 45 mm).…”

“…3 The question remains, whether replacement of the entire root should be performed in every patient. Papakonstantinou et al 1 present the clinical results of different approaches and have performed a separate sinus replacement combined with internal annuloplasty. This technique has been described elsewhere by authors before.…”