Surgical correction of aortic regurgitation using a HAART 300™ rigid aortic ring: A novel method to standardize aortic valve repair

Gocoł, Radosław; Jasiński, Marek; Hudziak, Damian; Bis, Jarosław; Żak, Aleksandra; Duraj, Piotr; Mizia, Magdalena; Rankin, J. Scott; Deja, Marek

doi:10.5603/cj.2019.0118

Cited by 9 publications

(11 citation statements)

References 10 publications

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“…In our study, we found a similar advantage of circumferential annuloplasty even when performed without additional root reimplantation. Other authors have recently shown promising results of internal or external rings, including suture-based annuloplasty, the Coroneo expandable ring and the HAART annuloplasty device [ 13 , 20 , 21 ]. The universal and reproducible technique of recreating symmetrical BAV has been recommended [ 13 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Bicuspid aortic valve repair: outcomes after 17 years of experience

Jasiński

Kosiorowska

Gocoł

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES This study presents the results of 17 years of experience with bicuspid aortic valve (BAV) repair and the analysis of factors associated with repair failure and early echocardiographic outcome. METHODS Between 2003 and 2020, a total of 206 patients [mean age: 44.5 ± 15.2 years; 152 males (74%)] with BAV insufficiency with or without aortic dilatation underwent elective aortic valve repair performed by a single surgeon with a mean follow-up of 5 ± 3.5 years. The transthoracic echocardiography examinations were reported. RESULTS There were no deaths during the hospital stay, and all but 1 patient survived the follow-up period (99.5%). Overall, 10 patients (5%) developed severe insufficiency and 2 (1%) developed aortic dilatation requiring reoperation. Freedom from reoperation at 7 years reached 91.8%. Type 2 BAV configuration [hazard ratio (HR) 3.9; 95% confidence interval (CI): 1.01–60; P = 0.049], no sinotubular junction remodelling (HR 7; 95% CI: 1.7–23; P = 0.005), no circumferential annuloplasty (HR 3.9; 95% CI: 1.01–64; P = 0.047) and leaflet resection (HR 5.7; 95% CI 1.2–13. P = 0.017) have been identified as a risk factor of redo operation. Parameters of the postoperative left ventricle reverse remodelling improved significantly early after the operation and later at 2 years evaluation. CONCLUSIONS The repair of BAV offers good short- and mid-term results providing a significant reverse left ventricular remodelling. Type 0 BAV preoperative configuration, circumferential annuloplasty and sinotubular junction remodelling are associated with better repair durability.

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Section: Discussionmentioning

confidence: 99%

Bicuspid aortic valve repair: outcomes after 17 years of experience

Jasiński

Kosiorowska

Gocoł

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…Annuloplasty also can be performed by circumferential suture annuloplasty, 5 usually reducing annular diameter to an arbitrary dimension-which again may not be uniformly accurate. We suggest that annuloplasty guided by leaflet size may be more objective, and this technique currently is being applied widely for tri-leaflet, 17 bicuspid, 26 and unicuspid AVr. 27 Geometric ring annuloplasty could provide a platform for standardizing AVr, but more experience and follow-up will be necessary for full validation.…”

Section: Discussionmentioning

confidence: 99%

“…The early clinical results of aortic ring annuloplasty as an adjunct to AVr have been presented elsewhere. 12,13,17 -20 At this point in time, approximately 1,000 rings have been implanted clinically for 40 different AI pathologies, with an AI repair rate exceeding 90%. 11 Long-term follow-up data are becoming available and demonstrate an 8-year Kaplan-Meier freedom from all-cause death and reoperation exceeding 80%, 21 consistent with other repair outcomes.…”

Section: Discussionmentioning

confidence: 99%

Leaflet Dimensions as a Guide to Remodeling Annuloplasty During Aortic Valve Repair

Jasiński

Rankin

Mazzitelli

et al. 2021

Innovations�(Phila)

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Objective In chronic aortic insufficiency (AI), the method and degree of annular downsizing required to achieve durable coaptation in aortic valve repair (AVr) remains poorly defined. This study evaluated the relationship between leaflet size and annular diameter to predict adequate annular sizing in remodeling AVr. Methods Under regulatory supervision, 74 patients with chronic tri-leaflet AI underwent AVr using ring annuloplasty and leaflet reconstruction. Fifty-four (73%) had ascending aortic ( n = 25) and/or root ( n = 29) aneurysms, and aortic grafts were sized 5 to 7 mm larger than the rings. Intraoperatively, leaflet free-edge length (FEL) was measured with special ball sizers positioned in the coronary sinus, and “normal” annular diameter was predicted from the validated formula: Required “normal” diameter = FEL/1.5. “Normal” annular diameters predicted from FEL were compared with pathologic diameters measured intraoperatively with Hegar dilators, and both were correlated with gender, age, and BSA. Results Average age was 62.1 ± 13.3 years (mean ± SD), 73% (54/74) were male, and 96% (71/74) had moderate-to-severe AI. All patients had annular dilatation, with a pathologic diameter 26.6 ± 2.3 mm before repair, and a predicted “normal” diameter of 21.7 ± 1.7 mm ( P < 0.001). Both predicted and pathologic annular diameters were larger in men ( P < 0.001), but no relationship existed with age. BSA correlated with both predicted and pathologic diameters, although variability was large. Conclusions Based on a simple validated method to predict “normal” annular diameter, all patients with chronic AI have some degree of annular dilatation. This finding implies that most AVr should include annuloplasty, with adequate and precise annular reduction based on leaflet size.

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“…The following techniques were used for aortic valve repair and aortic annulus stabilization: external stabilization with polytetrafluoroethylene (PTFE) suture [ 10 ] or Dacron graft ring (full or semicircular) [ 11 ], internal stabilization: with Cabrol stitch (subcommissural plication) [ 12 ], PTFE suture [ 13 ] or rigid HAART 300 ring (BioStable Science and Engineering, Austin, TX) [ 14 ]. The following techniques were used for aortic valve cusp repair: central plication, free edge plication with the use of PTFE suture, cusp reconstruction with pericardial patch, cusp shaving and decalcification [ 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of bicuspid and tricuspid aortic valve repair

Gocoł

Bis

Malinowski

et al. 2020

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44–56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96–37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99–9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

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Surgical correction of aortic regurgitation using a HAART 300™ rigid aortic ring: A novel method to standardize aortic valve repair

Cited by 9 publications

References 10 publications

Bicuspid aortic valve repair: outcomes after 17 years of experience

Bicuspid aortic valve repair: outcomes after 17 years of experience

Leaflet Dimensions as a Guide to Remodeling Annuloplasty During Aortic Valve Repair

Comparison of bicuspid and tricuspid aortic valve repair

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