Predictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.

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A Regulated Trial of Bicuspid Aortic Valve Repair Supported by Geometric Ring Annuloplasty

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2015.01.050 ◽

2015 ◽

Vol 99 (6) ◽

pp. 2010-2016 ◽

Cited By ~ 23

Author(s):

Domenico Mazzitelli ◽

Steffen Pfeiffer ◽

J. Scott Rankin ◽

Theodor Fischlein ◽

Yeong-Hoon Choi ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valve Repair ◽

Valve Repair ◽

Ring Annuloplasty

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Bicuspid aortic valve repair with external or subcommissural annuloplasty—echocardiographic prospective trial

Journal of Cardiac Surgery ◽

10.1111/jocs.16154 ◽

2021 ◽

Author(s):

Marek Jasinski ◽

Tomasz Plonek ◽

Radoslaw Gocol ◽

Piotr Pysz ◽

Damian Hudziak ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Prospective Trial ◽

Aortic Valve Repair ◽

Valve Repair

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Bicuspid aortic valve repair in the setting of severe AR

ASVIDE ◽

10.21037/asvide.2018.514 ◽

2018 ◽

Vol 5 ◽

pp. 514-514

Author(s):

Ziv Beckerman ◽

Michael O. Kayatta ◽

LaRonica McPherson ◽

Jose N. Binongo ◽

Yi Lasanajak ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valve Repair ◽

Valve Repair

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Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa009 ◽

2020 ◽

Vol 57 (6) ◽

pp. 1137-1144

Author(s):

Oliver K Jawitz ◽

Vignesh Raman ◽

Jatin Anand ◽

Muath Bishawi ◽

Soraya L Voigt ◽

...

Keyword(s):

Aortic Valve ◽

Transoesophageal Echocardiography ◽

Aortic Disease ◽

Aortic Insufficiency ◽

Aortic Valve Repair ◽

Valve Repair ◽

Annuloplasty Ring ◽

Aortic Repair ◽

Early Results

Abstract OBJECTIVES Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports ‘real-world’ early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/− root +/− arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS The median age was 58 years [interquartile range (IQR) 46–70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3–4+ in 37 (79%) patients. Forty-one (87%) patients had zero–trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5–20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10–13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

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