Isolated Tricuspid Aortic Valve Repair With Double Annuloplasty: How I Teach It

Youssefi, Pouya; Brega, Carlotta; Shraer, Nathanael; Žáček, Pavel; Debauchez, Mathieu; Lansac, Emmanuel

doi:10.1016/j.athoracsur.2019.07.008

Cited by 10 publications

(10 citation statements)

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“…An isolated AV repair can only be performed if both the sinuses of Valsalva and ascending aorta are less than 45 mm (otherwise a valve-sparing root replacement with subvalvular annuloplasty, or a tubular aorta replacement with subvalvular annuloplasty will need to be performed). [4][5][6] It is important for the trainee to appreciate the importance of addressing the three different geometric components of the aortic root when embarking on AV repair: the annulus, the STJ, and the valve cusps. Central to addressing the annulus and the STJ is the restoration of the normal physiologic STJ/ annulus ratio of 1.2.…”

Section: Preparationmentioning

confidence: 99%

“…For management of fenestrations, commissural diastasis, calcification, and the minor form of BAV with close to 120-degree commissural angle, please see the previous three articles in the series. [4][5][6] Dilated Ascending Aorta/Borderline Dilated Root…”

Section: Specific Lesion Setsmentioning

confidence: 99%

“…Previously, we have described root remodeling and annuloplasty in both TAV and BAV, as well as isolated AV repair in TAV. [4][5][6] In this fourth article, we describe our approach to teaching isolated AV repair using double subvalvular and supravalvular annuloplasty in BAV.…”

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confidence: 99%

“…a Hegar dilator.Adapted from Youssefi and colleagues6 with permission from The Society of Thoracic Surgeons. STJ, sinotubular junction.…”

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confidence: 99%

“…This is the final article in a series of four, which have aimed to take a deep dive into teaching the advanced techniques of AV and root repair. [4][5][6] We believe the key to the dissemination of AV repair techniques for the treatment of dystrophic AI is the standardization and simplification of the steps and repair strategies, which can only be successful if there is logic and evidence behind them. The success of a procedure is dependent not only by its outcomes, but also by its reproducibility by different surgeons from around the world.…”

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confidence: 99%

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Isolated Bicuspid Aortic Valve Repair With Double Annuloplasty: How I Teach It

Youssefi

Brega

Shraer

et al. 2019

The Annals of Thoracic Surgery

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F ollowing on from the success of mitral valve repair, aortic valve (AV) repair is now recognized as a recommended treatment for selected patients with aortic insufficiency (AI) or proximal aorta aneurysm. In recent years, the main schools of aortic valve (AV) repair have standardized the approaches and techniques to enhance the reproducibility of AV repair. International guidelines now recommend a "heart team discussion" for selected patients with "pliable, non-calcified tricuspid or bicuspid" AI "in whom aortic valve repair may be a feasible alternative to valve replacement" (Class I C indication). 1 We have developed a standardized technique for aortic valve repair that is reproducible, and consists of a systematic approach to allow the surgeon to safely and competently embark on the correct strategy for valve repair. We have taught these techniques at our international courses, with many surgeons having learned to perform these operations using these standardized steps. The technique addresses the valve cusps as well as the annulus and sinotubular junction (STJ). 2 The physiologic ratio of STJ/annulus is 1.2, 3 and we restore root geometry back to this ratio using a double subvalvular and supravalvular annuloplasty. We also perform systematic effective height assessment and resuspension. This is the fourth and final article of the series, which are deep dives into how we teach the standardized techniques of aortic root and valve repair, including root replacement in tricuspid aortic valves (TAV) and bicuspid aortic valves (BAV), as well as isolated repair of TAV and BAV (Figure 1). Previously, we have described root remodeling and annuloplasty in both TAV and BAV, as well as isolated AV repair in TAV. [4][5][6] In this fourth article, we describe our approach to teaching isolated AV repair using double subvalvular and supravalvular annuloplasty in BAV.

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Section: Preparationmentioning

confidence: 99%

Section: Specific Lesion Setsmentioning

confidence: 99%

mentioning

confidence: 99%

“…a Hegar dilator.Adapted from Youssefi and colleagues6 with permission from The Society of Thoracic Surgeons. STJ, sinotubular junction.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Isolated Bicuspid Aortic Valve Repair With Double Annuloplasty: How I Teach It

Youssefi

Brega

Shraer

et al. 2019

The Annals of Thoracic Surgery

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Aortic valve cusp size and shape in dilated trileaflet aortic roots

Jelenc,

Habjan

et al. 2024

The Journal of Thoracic and Cardiovascular Surgery

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Starting an aortic valve repair program: is it worthwhile? Aortic valve repair compared to replacement

Meuris

Vervoort

Praetere

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Increasing evidence suggests that aortic valve (AV) repair may have better long-term outcomes than AV replacement for aortic insufficiency. However, most literature is limited to centres of excellence and has not sufficiently been replicated in nascent programs. This single-centre experience of a newly established AV repair program aims to compare short-term outcomes of AV sparing versus replacement surgery. METHODS A retrospective cohort study of patients who underwent elective surgery for aortic regurgitation or aortic root dilatation at the Leuven University Hospital between 2013 and 2018 was performed. Patients with a critically ill presentation, endocarditis, aortic stenosis or requiring redo surgery were excluded. Patients were assigned to repair versus replacement based on preoperative intention to preserve the AV. Nearest neighbour propensity score matching was performed to compare both groups. Safety (mortality, morbidity), efficiency (cross-clamp and bypass times) and efficacy end points (repair rate, postoperative echocardiography) were compared. RESULTS One hundred and seven patients underwent AV surgery (48 repair, 59 replacement), from which 2 groups of 23 matched patients were created. There were 1 death and 2 reoperations after repair and no death and 1 reoperation after replacement. Extracorporeal circulation and aortic cross-clamp time were significantly longer while ventilation and total hospital stay were significantly shorter after AV repair. Echocardiographic follow-up showed comparable aortic regurgitation but lower transvalvular gradients after repair. Freedom from major complications was comparable in both cohorts. CONCLUSIONS Early results suggest the feasibility of replicating experienced centres’ perioperative and short-term outcomes in nascent programs.

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Isolated Tricuspid Aortic Valve Repair With Double Annuloplasty: How I Teach It

Cited by 10 publications

References 9 publications

Isolated Bicuspid Aortic Valve Repair With Double Annuloplasty: How I Teach It

Isolated Bicuspid Aortic Valve Repair With Double Annuloplasty: How I Teach It

Aortic valve cusp size and shape in dilated trileaflet aortic roots

Starting an aortic valve repair program: is it worthwhile? Aortic valve repair compared to replacement

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