Multiple Valve Repair Facilitated by Aortic Ring Annuloplasty

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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Functional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2018.06.056 ◽

2019 ◽

Vol 107 (1) ◽

pp. 68-75 ◽

Cited By ~ 2

Author(s):

Hanjo Ko ◽

Joseph E. Bavaria ◽

Andreas Habertheuer ◽

John G. Augoustides ◽

Mary A. Siki ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Functional Outcomes ◽

Aortic Ring ◽

Aortic Valve Repair ◽

Type I ◽

Valve Repair

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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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Early Clinical Experience with Double Ring Implantation for Aortic and Mitral Valve Repair

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1667324 ◽

2018 ◽

Vol 67 (07) ◽

pp. 561-563

Author(s):

M. Russo ◽

M. Andreas ◽

S. J. Rankin ◽

F. Maisano ◽

A. Weber

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Clinical Experience ◽

Aortic Ring ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Valve Repair ◽

Double Ring ◽

End Diastolic Volume ◽

Early Results

AbstractReconstruction of cardiac valves is associated with reduced mortality, including in multiple valve surgery. However, multiple valve repair is still considered a challenge, even with established techniques. Recently, internal aortic ring annuloplasty has been introduced and could simplify multiple valve reconstruction. This study reports early results with double ring aortic and mitral valve repair. Three patients with bivalvular degenerative regurgitation were managed with combined aortic and mitral valve repair using double rings. Mean (±SD) age was 41 ± 21 years, preoperative left ventricular end-diastolic volume was 119 ± 53 mL/m2, and ejection fraction was 0.50 ± 0.07. Mean aortic ring diameter was 21 mm, and mitral rings averaged 32 mm. No operative mortalities or major complications were observed. No valve-related events occurred. Postoperative echo showed complete resolution of mitral and aortic regurgitation. Postoperative left ventricular end-diastolic volume decreased to 98 ± 10 mL/m2; no left ventricular outflow tract obstruction or significant transvalvular gradients were observed. Postoperative cardiac CTs showed an optimal three-dimensional configuration of aortic and mitral annuloplasty devices. This initial series demonstrated the feasibility and safety of combined aortic and mitral repair with double rings. Clinical and hemodynamic results were promising. Increasing application and more clinical experience with combined aortic and mitral double ring repair seems indicated.

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