Deep circumferential annuloplasty as an adjunct to repair regurgitant bicuspid aortic valves with a dilated annulus

Abstract

Regurgitant BAVs with a dilated annulus display anterior cusp prolapse toward the septum. A deep circumferential annuloplasty may help maintain repair durability.

Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment

“…Early repair failure is associated with failure to address the functional aortic annulus in the process of BAV repairment. The deep anterior dissection technique not only avert the problem, but also acquires another goals including making the annuloplasty ring surrounded by the basal ring, permitting to symmetrical implantation, making the tissues of the root anteriorly become thin, causing less muscle bands and improving the accuracy of grafting sizing and matching and preventing recurrence of dilatation in the same area and prolapse of conjoined cusp by IVS (Nawaytou et al, 2018).…”

“…If the regurgitation BAV patient combines with annular dilatation, the repair treatment might not be successful. Sub-commissural annuloplasty resulted in earlier repair failures compared with complete circumferential annuloplasty (Navarra et al, 2013; Nawaytou et al, 2018). Suture annuloplasty with polytetrafluorethylene as material could eliminated annular dilatation and reduce local complications and tissue trauma.…”

Isolated aortic valve repair—how to do it and long-term results: suture annuloplasty

“…We feel that an external device is most likely superior because of better stress distribution and avoidance of interference with the aortic valve cusps. Of the external devices, different rings have been employed (14,15). In the presence of a high aortoventricular junction the implantation of an external ring may be difficult and might lead to anatomic distortion or would require deep circumferential dissection (15).…”

Aortic Root Remodeling

“…3,12 In direct comparison root remodeling has been the procedure that requires less dissection (at least if done without a ring annuloplasty) and shorter ischemic times. This is particularly so if muscle extension into the sinus is present; in that scenario reimplantation would require very deep dissection, 21 which is feasible but traumatic. Experimental studies have shown better preservation of cusp motion with remodeling 22,23 ; whether this translates into better true long-term valve durability with the potential of a life-long cure still remains to be shown.…”