Rationale for Aortic Annuloplasty to Standardise Aortic Valve Repair

Overview

Journal Ann Cardiothorac Surg

Publisher AME Publishing Company

Date 2019 Jun 27

PMID 31240176

Citations 7

Authors

Pouya Youssefi

Ismail El-Hamamsy

Emmanuel Lansac

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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References

Lansac E, Lim H, Shomura Y, Lim K, Rice N, Goetz W . A four-dimensional study of the aortic root dynamics. Eur J Cardiothorac Surg. 2002; 22(4):497-503. DOI: 10.1016/s1010-7940(02)00405-0. View

Iung B, Baron G, Butchart E, Delahaye F, Gohlke-Barwolf C, Levang O . A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003; 24(13):1231-43. DOI: 10.1016/s0195-668x(03)00201-x. View

Taylor W, THROWER W, Black H, HARKEN D . The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg. 1958; 35(2):192-205 passim. View

David T, Feindel C . An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992; 103(4):617-21; discussion 622. View

Lansac E, Di Centa I, Varnous S, Rama A, Jault F, Duran C . External aortic annuloplasty ring for valve-sparing procedures. Ann Thorac Surg. 2004; 79(1):356-8. DOI: 10.1016/j.athoracsur.2003.10.103. View

Lansac E, Di Centa I, Bonnet N, Leprince P, Rama A, Acar C . Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure?. Eur J Cardiothorac Surg. 2006; 29(4):537-44. DOI: 10.1016/j.ejcts.2005.12.055. View

Schafers H, Bierbach B, Aicher D . A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006; 132(2):436-8. DOI: 10.1016/j.jtcvs.2006.04.032. View

Ranga A, Bouchot O, Mongrain R, Ugolini P, Cartier R . Computational simulations of the aortic valve validated by imaging data: evaluation of valve-sparing techniques. Interact Cardiovasc Thorac Surg. 2007; 5(4):373-8. DOI: 10.1510/icvts.2005.121483. View

Le Polain De Waroux J, Pouleur A, Goffinet C, Vancraeynest D, Van Dyck M, Robert A . Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation. 2007; 116(11 Suppl):I264-9. DOI: 10.1161/CIRCULATIONAHA.106.680074. View

10.

Anderson R, Devine W, Ho S, Smith A, McKay R . The myth of the aortic annulus: the anatomy of the subaortic outflow tract. Ann Thorac Surg. 1991; 52(3):640-6. DOI: 10.1016/0003-4975(91)90966-t. View

11.

Cosgrove D, Rosenkranz E, Hendren W, Bartlett J, STEWART W . Valvuloplasty for aortic insufficiency. J Thorac Cardiovasc Surg. 1991; 102(4):571-6; discussion 576-7. View

12.

Detaint D, Jondeau G . [Dystrophic aortic insufficiency]. Rev Prat. 2009; 59(2):187-93. View

13.

Lansac E, Di Centa I, Raoux F, Bulman-Fleming N, Ranga A, Abed A . An expansible aortic ring for a physiological approach to conservative aortic valve surgery. J Thorac Cardiovasc Surg. 2009; 138(3):718-24. DOI: 10.1016/j.jtcvs.2009.05.024. View

14.

Bierbach B, Aicher D, Issa O, Bomberg H, Graber S, Glombitza P . Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg. 2010; 38(4):400-6. DOI: 10.1016/j.ejcts.2010.01.060. View

15.

Frater R, Anderson R . How can we logically describe the components of the arterial valves?. J Heart Valve Dis. 2010; 19(4):438-40. View

16.

Aicher D, Kunihara T, Abou Issa O, Brittner B, Graber S, Schafers H . Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011; 123(2):178-85. DOI: 10.1161/CIRCULATIONAHA.109.934679. View

17.

Fattouch K, Sampognaro R, Speziale G, Ruvolo G . New technique for aortic valve functional annulus reshaping using a handmade prosthetic ring. Ann Thorac Surg. 2011; 91(4):1154-8. DOI: 10.1016/j.athoracsur.2010.12.050. View

18.

Schomburg J, Lahti M, Ruth G, Bianco R . Internal aortic annuloplasty: a novel technique. J Invest Surg. 2011; 24(5):222-6. DOI: 10.3109/08941939.2011.575916. View

19.

de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde J, Noirhomme P . Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg. 2011; 142(6):1430-8. DOI: 10.1016/j.jtcvs.2011.08.021. View

20.

Anderson R . Demolishing the tower of babel. Eur J Cardiothorac Surg. 2012; 41(3):483-4. DOI: 10.1093/ejcts/ezr104. View