An aortic ring to standardise aortic valve repair: preliminary results of a prospective multicentric cohort of 144 patients
| Autor: | Ghassan Sleilaty, Isabelle Di Centa, Olivier Bouchot, Emmanuel Lansac, Mathieu Debauchez, Christophe Acar, Dominique Blin, Eric Arnaud Crozat |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic valve Marfan syndrome Adult Male Reoperation medicine.medical_specialty Aortic Valve Insufficiency Cardiac Valve Annuloplasty Marfan Syndrome Aortic aneurysm Young Adult Aneurysm Aortic valve repair Bicuspid valve Internal medicine Mitral valve medicine.artery medicine Humans Prospective Studies Aged Aged 80 and over Aorta business.industry General Medicine Prostheses and Implants Middle Aged medicine.disease Surgery Aortic Aneurysm medicine.anatomical_structure Treatment Outcome Aortic Valve cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 38(2) |
| ISSN: | 1873-734X |
| Popis: | Objectives: Multiplicity of aortic valve repair or sparing techniques results in a lack of standardisation, limiting widespread adoption of such procedures. To treat dilated diameters at the aortic annular base and sinotubular junction while maintaining root dynamics, we propose a standardised and physiological repair approach to the surgical management of aortic root aneurysms, consisting of root remodelling, cusp resuspension and subvalvular aortic ring annuloplasty. Methods: From May 2003 to September 2009, 144 unselected patients with aortic root aneurysms underwent remodelling with external subvalvular ring annuloplasty in 13 centres (21 surgeons). Preoperative aortic insufficiency (AI) grade 2 was present in 63.9% (92), Marfan syndrome in 12.5% (18) and bicuspid valve in 22.9% (33). Cusp repair was performed in 40.3% (58) patients. Results: Valve repair was successful in all but two cases. Repair of cusp prolapse was necessary in 58 patients, significantly more frequent in bicuspid (24/33, 72.7%) than in tricuspid (34/111, 30.6%) valves (p < 0.05). Operative mortality was 2.8% (four). Subvalvular ring implantation produced a significant annular base reduction from 27.6 2.5 mm to 20.5 2.6 mm (p < 0.01) without significant mean transvalvulargradient (7.2 1.7 mmHg).Duringfollow-up(median2.2years(0.75—4.4,maximum6.25years)),fivepatientsdiedwhileeightrequired a re-operation. Six were operated on during our early experience. Strategy for cusp re-suspension evolved over three operative periods, with a significant increase in the rate of cusp repair. From May 2003 to December 2006: eye balling evaluation (15/67 (22.4%)); from January 2007 to August 2008: alignment of cusp free edges (17/38 (44.7%)); and from September 2008 to September 2009: a two-step standardised repair consisting of alignment of cusp free edges and effective height re-suspension (26/39 (66.7%) p < 0.05). Freedom from AI grade 2 was 91.3% (115) at the end of follow-up. Conclusions: Implantation of an external aortic ring provides a reproducible technique for aortic valve repair with satisfactory preliminary results. The ongoing CAVIAAR trial (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root) will compare this standardised repair technique using an expansible aortic ring to mechanical valve replacement. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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