An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Holubec, Tomáš; Higashigaito, Kai; Bëlobrádek, Z; Děrgel, Martin; Harrer, Jan; Alkadhi, Hatem; Žáček, Pavel; Vojacek, Jan

doi:10.1016/j.athoracsur.2016.05.098

Cited by 16 publications

(4 citation statements)

References 26 publications

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“…The two most commonly used annuloplasty techniques for aortic valve repair is the Dacron ring annuloplasty obtained from Dacron tube grafts (Vascutek, Terumo, Japan) and the polytetrafluoroethylene (PTFE) suture annuloplasty. Both annuloplasties have shown good results with or without the remodeling procedure (8)(9)(10)(11). However, some concerns have been raised regarding the expansibility of the Dacron ring annuloplasty throughout the cardiac cycle, because the material of the Dacron tube graft is less compliant than the native tissue and is thought to have limited radial expansion capacity.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Dacron ring and suture annuloplasty for aortic valve repair—a porcine study

Benhassen¹,

Røpcke²,

Sharghbin³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: A subvalvular annuloplasty is often used for aortic valve repair in patients with isolated aortic regurgitation with aortic annulus dilatation. Our aim was to characterize and compare annulus geometry and dynamics of the Dacron ring and suture annuloplasty and compare it with the native aortic annulus under standardized conditions. Methods: We randomized 29 pigs of 80 kg into a Dacron ring group, a suture annuloplasty group and a native control group. The assessment was performed using sonomicrometry crystals for evaluation of dynamic geometry, and pressure measurements and echocardiography to evaluate valve performance. Results: Aortic annulus area (AAA) was significantly reduced in the Dacron and Suture group compared with the Native group. Expansibility was similar and within normal physiologic limits in all three groups (Native: 12%±7%; Dacron: 11%±3%; Suture: 10%±4%). The largest segmental expansion was observed at the right coronary sinus (RC) in the Native and Dacron group but in the Suture group there was no significant difference between segments. The aortic annulus was primarily oval in systole and became more circular in diastole in the Native and Dacron group, however, in the Suture group, the sphericity remained relatively unchanged throughout the cardiac cycle. Conclusions: This study is the first to describe and compare detailed segmental geometry of the Dacron ring and suture annuloplasty in a standardized porcine model. The two annuloplasties effectively downsized the aortic annulus, while expansibility was maintained. Each annuloplasty had its own geometrical characteristics, but the Dacron ring was more similar to the native aortic annulus than the suture annuloplasty. This study suggests that the Dacron ring offers a more physiological and standardized support by mimicking the geometry and dynamics of the native aortic annulus and thus is a preferable choice over the suture annuloplasty for valve-sparing aortic root procedures.

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Section: Introductionmentioning

confidence: 99%

Comparison of Dacron ring and suture annuloplasty for aortic valve repair—a porcine study

Benhassen¹,

Røpcke²,

Sharghbin³

et al. 2019

Ann. Cardiothorac. Surg.

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“…Improved repair stability has been reported with the use of this technique in isolated BAV repair [ 2 ]. However, a study using CT imaging revealed that the Lansac ring was still partially above the VBR, especially at the level of the commissure between the left and right coronary sinuses in the tricuspid aortic valve non-functional commissure in type 1 R/L BAV and at the level of the right coronary sinus [ 28 ]. According to de Kerchove et al .…”

Section: Discussionmentioning

confidence: 99%

Assessment of Computed Tomography Imaging for Isolated Type 1 Bicuspid Aortic Valve Repair: A Comparison between Internal and External Suture Annuloplasty Techniques

Ni¹,

Fan²,

Li³

et al. 2023

Rev. Cardiovasc. Med.

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Background: The ideal position of suture annuloplasty relative to the aortic annulus (internal or external) remains unclear. This study aimed to investigate the effectiveness of internal and external suture annuloplasty for isolated type 1 bicuspid aortic valve (BAV) repair. Electrocardiogram (ECG)-gated computed tomography (CT) was used to compare the two techniques and analyze their impact on the aortic annulus. Methods: We retrospectively analyzed 20 patients who underwent isolated type 1 BAV repair with either internal or external suture annuloplasty. Each group included 10 patients with comparable clinical features. Preoperative and postoperative ECG-gated CT scans were performed to assess the anatomical relationship between the ventricular-aortic junction (VAJ) and virtual basal ring (VBR), and to measure the height of annuloplasty from the VBR at predefined landmarks in both groups. Perioperative annular geometries, including annular area and perimeter, were measured to quantify the impact of annuloplasty on annular expansibility. The discrepancy between the postoperative annular dimension and size of the Hegar dilator were compared between groups to evaluate the effectiveness of annuloplasty. Results: In both groups, VAJ was higher than VBR at the right coronary (RC) ostium (7.7 3.3 mm) and the raphe (7.9 1.5 mm). The height from the VBR to the external suture annuloplasty shared a similar pattern at the RC ostium and raphe (5.3 1.1 mm and 4.8 1.0 mm, respectively). In contrast, the height differences were minimal for these landmarks in the internal group. Postoperative annular area expansibility decreased in the internal group compared to preoperative levels (4.9 2.3% vs. 8.9 5.5%, p = 0.038), while no significant change was found in the external group (7.6 4.1% vs. 6.5 2.8%, p = 0.473). The internal group showed less area discrepancy between the VBR and the Hegar dilator both at systole (10.1 3.7% vs. 30.1 16.6%, p = 0.004) and diastole (5.7 4.9% vs. 20.9 14.5%, p = 0.009) compared to the external group. Conclusions: Internal suture annuloplasty results in better positioning relative to the VBR than external suture annuloplasty due to the absence of VAJ interference. While this results in more precise annular reduction and less expansibility in the short term, a long-term follow-up evaluation is necessary to assess its effectiveness.

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“…We thank Yurekli and colleagues [1] for their letter on our article titled "An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study" [2].…”

Section: Reply To the Editormentioning

confidence: 99%

The Coroneo External Annuloplasty Ring

Yurekli

Kestelli

Cakir

et al. 2018

The Annals of Thoracic Surgery

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An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Abstract: This study demonstrates imaging evidence of the effectiveness, stability, and pulsatility of the annuloplasty ring in aortic root remodeling in follow-up and describes the exact position of the ring at the base of the aortic root.

Cited by 16 publications

References 26 publications

Comparison of Dacron ring and suture annuloplasty for aortic valve repair—a porcine study

Comparison of Dacron ring and suture annuloplasty for aortic valve repair—a porcine study

Assessment of Computed Tomography Imaging for Isolated Type 1 Bicuspid Aortic Valve Repair: A Comparison between Internal and External Suture Annuloplasty Techniques

The Coroneo External Annuloplasty Ring

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