Standardized approach to valve repair using an expansible aortic ring versus mechanical Bentall: Early outcomes of the CAVIAAR multicentric prospective cohort study

Lansac, Emmanuel; Bouchot, Olivier; Crozat, Eric Arnaud; Hacini, Rachid; Doguet, Fabien; Demaria, Roland; Leguerrier, Alain; Jouan, Jérôme; Chatel, Didier; Lopez, Stéphane; Folliguet, Thierry; Acar, Christophe; Leprince, Pascal; Langanay, Thierry; Jegaden, Olivier; Bessou, Jean Paul; Albat, Bernard; Latrémouille, Christian; Fabiani, Jean‐Noël; Fayad, Georges; Fleury, Jean; Pasquet, Blandine; Debauchez, Mathieu; Centa, Isabelle Di; Tubach, Florence

doi:10.1016/j.jtcvs.2014.07.105

Cited by 57 publications

(26 citation statements)

References 32 publications

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“…The safety of VSRR using the remodeling technique and expansible subvalvular annuloplasty has been demonstrated by the CAVIAAR trial showing similar 30-day mortality compared to a mechanical Bentall procedure, with a trend towards more major adverse events in the Bentall group (OR 2.52, P=0.09) (55). At 4 years, crude and propensitymatched analyses confirmed that freedom from valverelated death and freedom from hemorrhagic events are significantly higher after valve repair than replacement; respectively 99% vs. 94% (P<0.001) and 89% vs. 78% (P=0.02), whereas freedom from valve-related reoperation was similar (P=0.22).…”

Section: Aortic Annuloplasty: a Standardised Approach To Av Repairmentioning

confidence: 96%

Rationale for aortic annuloplasty to standardise aortic valve repair

Youssefi¹,

El-Hamamsy²,

Lansac³

2019

Ann. Cardiothorac. Surg.

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Available evidence shows that aortic valve repair reduces valve-related mortality and improves quality of life compared to prosthetic aortic valve replacement. One of the most important predictors of bicuspid and tricuspid aortic valve repair failure is the absence of treating a dilated aortic annulus greater than 25-28 mm. Competency of the aortic valve depends on multiple factors including the diameter of the annulus, sinotubular junction, valve cusps and commissures. Dystrophic aortic insufficiency (AI) is the commonest cause of AI in the Western world and is characterised by dilatation of the aortic annulus (≥25 mm), sinuses and/or sinotubular junction (≥30 mm). Depending on whether the sinuses of Valsalva and/or tubular ascending aorta are dilated, three phenotypes can be identified: dilated aortic root, dilated ascending aorta and isolated AI. All three phenotypes are associated with a dilated aortic annulus. Aortic annuloplasty reduces the dilated aortic annulus and improves the surface of coaptation, as in the case of mitral valve repair. In treating AI, it is also important to restore the physiological sinotubular junction/annulus ratio, which can be carried out with remodeling root repair + subvalvular annuloplasty (for dilated aortic root), tubular ascending aorta replacement + subvalvular annuloplasty (for dilated ascending aorta) and double sub-and supra-valvular annuloplasty (for isolated AI). Aortic annuloplasty is now considered an essential component of aortic valve repair and valve-sparing root surgery.

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Section: Aortic Annuloplasty: a Standardised Approach To Av Repairmentioning

confidence: 96%

Rationale for aortic annuloplasty to standardise aortic valve repair

Youssefi¹,

El-Hamamsy²,

Lansac³

2019

Ann. Cardiothorac. Surg.

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“…It was emphasized, however, that resultant discrepancy of effective height of each cusp should be aggressively corrected for better cusp durability, as described above 27 . He launched a multicenter study of remodeling, and thus the quality of AVP should be reproducible between institutions 44,45 .…”

Section: Standardization Of Aortic Valve-preserving Surgerymentioning

confidence: 99%

Current trends in aortic valve-preserving surgery

Kunihara

2020

Preprint

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The natural history of patients with aortic regurgitation (AR) is not as benign as once believed, even in asymptomatic patients with preserved left ventricular function. Aortic valve surgery can prolong survival of these patients. However, both mechanical and biological aortic valve replacement have major disadvantages, especially in young patients. Aortic valve-preserving surgery (AVP) has attracted a great deal of attention as it has significant survival benefit over replacement. Nonetheless, AVP has not been widely adopted due to the complexity of its technique and assessment (i.e., long learning curve). With recent technical and theoretical advances, AVP has increasingly been performed with better outcomes, and therefore earlier indication for surgical intervention in cases of AR has been considered. Recent advances in AVP include repair-oriented classification of the etiology of AR, objective assessment of the cusp configuration (i.e., effective height and geometric height), use of aortic annuloplasty, introduction of two reproducible valve-sparing root replacement procedures (i.e., aortic valve reimplantation and aortic root remodeling techniques), standardization of AVP, and assessment of cusp configuration with aortoscopy. A number of prospective multicenter studies are currently underway and will clarify the role of AVP in surgical treatment of AR in the near future.

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“…In addition, the ensuing dedicated and commercially available ring, which was developed and manufactured by Coroneo, Inc (Montreal, Quebec, Canada) in collaboration with Lansac, was first implanted in Europe in a prospective, multicentric clinical trial (CAVIAAR; https://clinicaltrials.gov/ct2/show/ NCT00478803). Early and long-term clinical results from European centers have since been reported [4][5][6].…”

Section: Reply To the Editormentioning

confidence: 99%