Leaflet Reconstructive Techniques for Aortic Valve Repair

Mazzitelli, Domenico; Stamm, Christof; Rankin, J. Scott; Pfeiffer, Steffen; Fischlein, Theodor; Pirk, Jan; Choi, Yeong‐Hoon; Detter, Christian; Kroll, Johannes; Beyersdorf, Friedhelm; Shrestha, Malakh; Schreiber, Christian; Lange, Rüediger

doi:10.1016/j.athoracsur.2014.06.052

Cited by 19 publications

(18 citation statements)

References 29 publications

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“…Major structural leaflet defects usually were repaired with autologous pericardial techniques, and retracted Noduli were released using an ultrasonic device. 10 After valve repair, concomitant ascending aortic and/or aortic root aneurysms were managed with ascending aortic and/or remodeling root replacement, using Dacron tube or Valsalva remodeling grafts that were 5 to 7 mm larger than ring size. Specific details about operative technique are provided elsewhere.…”

Section: Methodsmentioning

confidence: 99%

“…3,4 Early operative outcomes for these devices have been published elsewhere, [4][5][6][7][8][9] including adjunctive leaflet repair techniques that were successfully applied. 10 This analysis was undertaken to assess the final 2-year outcomes of a clinical trial of aortic ring annuloplasty for aortic insufficiency (AI) associated with ascending aortic and/or aortic root aneurysms.…”

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confidence: 99%

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Geometric Ring Annuloplasty for Aortic Valve Repair during Aortic Aneurysm Surgery

Rankin

Mazzitelli

Fischlein

et al. 2018

Innovations�(Phila)

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Objective An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms. Methods Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection. Valve repair was performed using trileaflet (n = 40) or bicuspid (n = 7) internal geometric rings, together with leaflet reconstruction. Ascending aortic and/or remodeling root replacements were accomplished with Dacron grafts 5 to 7 mm larger than the rings. An Echo Core Lab provided independent echocardiographic assessments, and changes over time were evaluated by Friedman tests. Results Mean ± SD age was 60 ± 14 years, 57% (27/47) were male, 15% (7/47) had bicuspid valves, 87% (41/47) had moderate-to-severe aortic insufficiency, and 13% (6/47) had mild aortic insufficiency. All patients had annular dilatation, with a mean ± SD of 26.5 ± 2.6 mm before repair, and mean ± SD ring sizes were 21.7 ± 1.7 mm. Follow-up was 42 months (mean = 27 months). No operative mortality or valve-related complications occurred. Two patients died beyond 1 year from nonvalve-related causes. One patient required valve replacement for repair failure. Survival free of complications or valve replacement was 94% at 2 years. Significant reduction in aortic insufficiency and New York Heart Association class were observed ( P < 0.0001), and valve gradients remained low. No heart block or direct ring complications occurred. Conclusions In preliminary regulatory studies, aortic ring annuloplasty seemed safe and effective during aortic aneurysm surgery. This approach could help standardize aortic valve repair.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Geometric Ring Annuloplasty for Aortic Valve Repair during Aortic Aneurysm Surgery

Rankin

Mazzitelli

Fischlein

et al. 2018

Innovations�(Phila)

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“…Over the first months after surgery, 2 patients required reoperation and prosthetic valve replacement for leaflet tears secondary to long annular suture tails (Fig 4). After that experience, a "lateral suture fixation" technique was instituted to direct the annular suture tails down and away from the leaflets [19]. The 4-0 Prolene annular sutures were tied tightly with eight knots (Fig 5), one or both needles were passed down through the lateral pledget, and the suture was tied again.…”

Section: Resultsmentioning

confidence: 99%

“…In the course of this study, bicuspid ring sizing and suture techniques were perfected, including the "lateral suture fixation" method to prevent suture-induced leaflet injuries [19]. The more effective annuloplasty seemed to facilitate the performance of concomitant leaflet procedures, including the reoperation case (patient 1) in whom the leaflet areas for both cusps were compromised.…”

Section: Commentmentioning

confidence: 99%

A Regulated Trial of Bicuspid Aortic Valve Repair Supported by Geometric Ring Annuloplasty

Mazzitelli

Pfeiffer

Rankin

et al. 2015

The Annals of Thoracic Surgery

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“…Aortic valve repair has evolved in a similar fashion based on 2 anatomically based concepts. First is the development of leaflet repair techniques [7] including free margin plication, pericardial patch augmentation, Nodular release, and minor calcium debridement [8]. The second is the development of a reproducible technique for stabilizing the aortic valve annulus, using a 3dimensional geometric remodeling ring implanted beneath the aortic valve annulus [9].…”

Section: Commentmentioning

confidence: 99%