Multiple-valve Repair Facilitated by Aortic Ring Annuloplasty

Gerdisch, Marc W.; Downey, Richard S.; Stavridis, George; Wei, Lawrence M.; Badhwar, Vinay; Rankin, J. Scott

doi:10.1016/j.athoracsur.2021.03.115

Cited by 1 publication

(2 citation statements)

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“…This probably is the mechanism of improved survival after AVr, similar to mitral and tricuspid repair. In fact, the risk‐adjusted odds ratios or hazard ratios for mortality associated with repairing any cardiac valve seem to approximate 0.5; and results seem to be additive, so that multiple valve repairs experience ever better risk reduction 24–26 . The technique employed in this series, however, was not without problems.…”

Section: Discussionmentioning

confidence: 83%

“…In fact, the risk-adjusted odds ratios or hazard ratios for mortality associated with repairing any cardiac valve seem to approximate 0.5; and results seem to be additive, so that multiple valve repairs experience ever better risk reduction. [24][25][26] The technique employed in this series, however, was not without problems. Four patients experienced reoperation long-term, and one died from repair failure.…”

Section: Discussionmentioning

confidence: 93%

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Minimally invasive aortic valve repair using geometric ring annuloplasty

Baker

Klokočovnik

Miceli

et al. 2021

Journal of Cardiac Surgery

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Objectives As aortic valve repair (AVr) for aortic insufficiency (AI) expands, minimally invasive (Mi) approaches are increasingly being applied. Cardiac surgical techniques can be more difficult through small incisions, and this report analyzes medium‐term outcomes for MiAVr facilitated by geometric ring annuloplasty. Methods Since 2013, 58 patients were selected for AVr through upper sternotomy third‐interspace incisions. The average age was 58.9 ± 15.4 (mean ± SD) years, 71% were male, and preoperative AI grade was 3.6 ± 0.8. Sixty‐two percent (36/58) had a proximal aortic replacement for ascending aortic aneurysms (n = 26) and/or remodeling grafts for aortic root aneurysms (n = 10). Annuloplasty rings were placed subannularly (69% trileaflet; 31% bicuspid), and leaflet procedures were performed in 70%. The average ring diameter was 21.6 ± 1.4 mm, and the average aortic clamp time was 113 ± 35 min. Results After repair, AI grade fell to an average of 0.5 ± 0.6 (p < .0001), with a mean valve gradient of 12.5 ± 7.1 mmHg. No operative mortalities or major complications occurred. Three patients required reoperations for bleeding, and two had pacemakers. At an average follow‐up of 38 months (maximal 88 months), three late deaths and no valve‐related complications were observed. Four patients required reoperative aortic valve replacement over follow‐up, and Kaplan–Meier survival and freedom from reoperation both exceeded 80% at 88 months. At the last follow‐up, the average AI grade was 0.7 ± 0.7, and the mean valve gradient was 12.7 ± 6.3 mmHg. Conclusions Geometric ring annuloplasty was safe and seemed to facilitate performing AVr ± proximal aortic replacement through Mi incisions. Hemodynamic improvements were significant, medium‐term clinical outcomes were acceptable, and results could improve further with experience.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 93%