A lesional classification to standardize surgical management of aortic insufficiency towards valve repair☆

Abstract

A lesional classification aims to standardize the surgical management of aortic valve repair: type Ia, by supra-coronary graft; type Ib, by subvalvular aortic annuloplasty associated with the aortic root replacement with a remodelling technique (root aneurysm) or double sub- and supravalvular annuloplasty (isolated AI). For chronic AI type II, aortic annuloplasty associated a remodelling technique or double sub- and supravalvular annuloplasty is combined with the treatment of the cusp lesion (cusp resuspension, cusp reconstruction with autologous pericardium).

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

“…6,48,49 In experienced centres, valve-sparing root replacement and valve repair, when feasible, yield good long-term results with low rates of valve-related events as well as better quality of life. [62][63][64][65] The choice of the surgical procedure should be adapted to the experience of the team, the presence of an aortic root aneurysm, characteristics of the cusps, life expectancy and desired anticoagulation status.…”

The 2017 ESC/EACTS guidelines on the management of valvular heart disease

“…Although valve replacement is the standard procedure in the majority of patients with aortic regurgitation, valve repair or valvesparing surgery should be considered in patients with pliable noncalcified tricuspid or bicuspid valves who have a type I (enlargement of the aortic root with normal cusp motion) or type II (cusp prolapse) mechanism of aortic regurgitation. 6,48,49 In experienced centres, valve-sparing root replacement and valve repair, when feasible, yield good long-term results with low rates of valve-related events as well as better quality of life. [62][63][64][65] The choice of the surgical procedure should be adapted to the experience of the team, the presence of an aortic root aneurysm, characteristics of the cusps, life expectancy and desired anticoagulation status.…”

An Expansible Aortic Ring for a Standardized and Physiological Approach of Aortic Valve Repair

“…On an echocardiographic study of patients with aortic root aneurysms (n=700) or isolated aortic insufficiency (n=595), average aortic annular base diameter was respectively 26.4mm (25-27.5mm) and 27.3mm (27-28mm), and average sinotubular junction was respectively 45.3mm (39.5-52.4mm) and 31mm (28-35mm). Ratio between the sinotubular junction and aortic annular base diameters was 1.7 in case of root aneurysms, whereas for isolated aortic insufficiency it was 1.1 (Lansac et al, 2008(Lansac et al, , 2010c.…”

“…Dystrophic aortic roots are characterized by dilation of both functional diameters of the aortic root: the aortic annular base and sino-tubular junction (STJ) diameters (>25mm and >35 mm respectively), preventing coaptation of otherwise thin and pliable valves (De Waroux et al, 2007;La Canna et al, 2009;Lansac et al, 2008Lansac et al, , 2010c. Cusp prolapse is often associated with root aneurysms and is the most common cause of isolated dystrophic aortic insufficiency (AI).…”

“…It includes two phenotypes depending on whether the sinuses of Valsalva and/or supracoronary aorta are dilated: 1) isolated AI and/or supracoronary aneurysm (sinuses of Valsalva<40 mm); 2) aortic root aneurysms (sinuses of Valsalva>45 mm) (Lansac et al, 2008). Until recently, prosthetic valve replacement was the only surgical option for AI, performing either isolated valve replacement, composite valve and graft replacement or supracoronary graft and/or valve replacement.…”