Remodeling root repair with an external aortic ring annuloplasty

Lansac, Emmanuel; Centa, Isabelle Di; Sleilaty, Ghassan; Lejeune, Stéphanie; Berrébi, Alain; Žáček, Pavel; Debauchez, Mathieu

doi:10.1016/j.jtcvs.2016.12.031

Cited by 130 publications

(112 citation statements)

References 30 publications

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“…Since 2003, we have operated on 482 patients using this standardized approach with 92% freedom for reoperation at 8 years similar for bicuspid and tricuspid valves according to each phenotype of the proximal aorta. Furthermore, since 2007 we have used systematic eH assessment and expansible calibrated annuloplasty ring (Extra-Aortic; CORONEO, Inc., Montreal, QC, Canada) with the remodeling process, which has improved freedom from AI grade ≥3 (100%), re-operation (99.1%) and major adverse valve-related events (96.3%) at 7 years follow-up with similar results for bicuspid and tricuspid valve repair (53). Systolo-diastolic expansibility of the annulus was preserved following the annuloplasty (5.1%±9.5%) (54).…”

Section: Aortic Annuloplasty: a Standardised Approach To Av Repairmentioning

confidence: 93%

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: 93%

Rationale for aortic annuloplasty to standardise aortic valve repair

Youssefi¹,

El-Hamamsy²,

Lansac³

2019

Ann. Cardiothorac. Surg.

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“…We feel that an external device is most likely superior because of better stress distribution and avoidance of interference with the aortic valve cusps. Of the external devices, different rings have been employed (14,15). In the presence of a high aortoventricular junction the implantation of an external ring may be difficult and might lead to anatomic distortion or would require deep circumferential dissection (15).…”

Section: Commentmentioning

confidence: 99%

Isolated aortic valve repair—how to do it and long-term results: suture annuloplasty

Schneider

Miyahara

Giebels

et al. 2019

Ann. Cardiothorac. Surg.

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“…Similarly de Kerchove and colleagues [12] found improved results with VSRR than with SCA, reporting freedom from reoperation and AI greater than 2þ better for the VSRR than for SCA (100% versus 90% and 100% versus 77%, respectively). Recently, Lansac and colleagues [23] reported good valve repair durability and annular stabilization with an expansible aortic ring annuloplasty. In their study they found a 7-year freedom from valve-related reoperation of 99.1%, freedom from valve-related events of 96.3%, freedom from AI grade 3 or Cumulative hazards estimates.…”

Section: Commentmentioning

confidence: 99%