Geometry of cusp and root determines aortic valve function

Matsushima, Shunsuke; Karliova, Irem; Gauer, Simon; Miyahara, Shunsuke; Schäfers, Hans‐Joachim

doi:10.1007/s12055-019-00813-2

Cited by 20 publications

(24 citation statements)

References 42 publications

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“…It is thus important that the surgeon systematically analyze the geometry of the valve that he sees in front of him when the aorta is open. 36 At times, and with experience, the surgeon will be ready to diagnose the mechanism of regurgitation at first look and will thus be ready to determine the necessary repair strategy. This may be the case in isolated cusp prolapse of a symmetric BAV or a TAV.…”

Section: Do Not Trust Looks!mentioning

confidence: 99%

The 10 Commandments for Aortic Valve Repair

Schäfers

2019

Innovations�(Phila)

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Section: Do Not Trust Looks!mentioning

confidence: 99%

The 10 Commandments for Aortic Valve Repair

Schäfers

2019

Innovations�(Phila)

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“…The aortic valve is a functional unit of cusps suspended within the aortic root. 3 Geometric alterations of either cusp or root will influence aortic valve form and competence.…”

Section: Anatomy Of the Aortic Valvementioning

confidence: 99%

“…The form of the aortic valve depends not only on root dimensions but also on dimensions of the aortic cusps. Geometric height, 3 ie, the distance from nadir to free margin, and the length of the free margin, 3 best defines cusp size. A normal aortic valve has a characteristic height difference between the free margins in diastole and the annular plane, termed effective height.…”

Section: Anatomy Of the Aortic Valvementioning

confidence: 99%

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Aortic annuloplasty: Subcommissural, intra-annular suture techniques, external and internal rings

et al. 2021

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Aortic valve repair and valve-preserving root replacement have evolved into increasingly practiced procedures. With increasing experience, the need for an annuloplasty has become more evident, at least for pathologies that involve annular dilatation. To understand the effect of an aortic annuloplasty, it is necessary to know the details of aortic valve and root anatomy. Geometrically, the functional annulus is best defined as the virtual basal ring, ie, plane of the cusp nadirs. The sinotubular diameter also influences the aortic valve form, at least in tricuspid valves. Different annuloplasty concepts have been developed for isolated valve repair or in combination with root remodeling, such as subcommissural sutures, suture annuloplasty, external, and internal rings. Subcommissural sutures do not consistently provide durable annular stabilization. More positive results have been published for circular approaches, ie, suture annuloplasty, external, or internal rings. The results of different techniques are difficult to judge because most outcome data have not been analyzed with control of confounding predictors of repair failure. The evidence that annuloplasty improves aortic valve function and repair durability is best documented for isolated bicuspid aortic valve repair. In summary, the addition of annuloplasty to aortic valve reconstruction is probably a useful tool to improve valve competence and stabilize the repair. This is best documented for isolated bicuspid valve repair and circular approaches. The relative benefit of individual concepts is difficult to judge because of lack of both control groups and control of confounding factors. (JTCVS Techniques 2021;7:98-102) Sinotubular junction Cusp free margin Crown-like cusp insertion line gH Virtual basal ring eH Determinants of aortic valve and root geometry. gH, Geometric height; eH, effective height.

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“…Using such a repair concept based on a geometric approach has improved applicability and results of repair. 5 AV repair has been shown to be associated with a very low incidence of valve-related complications, 6 and it probably improves postoperative survival. 7 AV repair is particularly essential for children and adolescents in whom avoidance of anticoagulation is particularly important.…”

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