Minimally invasive aortic valve repair using geometric ring annuloplasty

Abstract

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.

Early results of geometric ring annuloplasty for bicuspid aortic valve repair during aortic aneurysm surgery

“…A mechanical valve was placed. This sort of leaflet abrasion has been observed if the ring was sutured to the base of a leaflet (rather than 2 mm back into the annulus), as shown in a nonaneurysmal BAV repair reported previousy 24 ( Figure 4 , A ). No contact between ring polyester and leaflet tissue should be permitted.…”

Early Outcomes of Patients Undergoing Neoaortic Valve Repair Incorporating Geometric Ring Annuloplasty

“…Previous results with Nodular release have been good. 22,23,31 In one patient with severe nodular retraction, an artificial Nodulus was inserted to salvage the repair (Figure 2). Because of associated neoaortic root dilatation, root replacements using remodeling techniques were common.…”

“…Results of AVr with geometric rings have been excellent beyond seven years. 31 It should be stated, however, that the vast majority of these results have been defined for anatomically normal aortic valves, and not neoaortic leaflets. Therefore, the implied benefit of repair in the current congenital population is an extrapolation, but a reasonable assumption.…”

Aortic valve repair for isolated right coronary leaflet prolapse

“… 1 Recent Kaplan–Meier analysis including these patients showed a >80% survival and freedom from reoperation at 88 months of follow-up, consistent with standard repair-like outcomes. 9 Thus, the benefits of valve repair appear to be accrued to patients with isolated RCP using the methods described.…”