Remodeling technique of aortic valve repair with root replacement and extraaortic ring implantation

    Authors

    Keywords

    aortic valve insufficiency, aortic root repair, aortic valve repair

    DOI

    https://doi.org/10.15836/ccar2018.383

    Full Text

    Objective: Aortic valve replacement (AVR) is still the most commonly used therapeutic option for patients suffering from AR. Aortic valve repair (AVRep) is an attractive alternative method, since it avoids the risks of prosthesis-related complications. ( 1 , 2 ) We would like to present experience with the root remodeling, valve sparing technique with the extraaortic expansible ring. Patients and Methods: Between November 2014 and September 2018, a total of 65 patients (53.1±13.1 years; 18.5% female, EuroScore II of 0.48% to 11.17%) underwent AVRep; 8 due to isolated cusp malcoaptation and 57 with associated with aortic root dilatation. Reconstruction was done with the Coroneo Extraaortic Ring (27 (25-31)), and the Gelweave graft (28 (25-32)). Concomitant procedures included mitral valve reparation in 4 patients, with tricuspid valve reparation in two of them, coronary artery bypass graft in four patents. In two patients replacement of aortic arch was performed and placement of EVITA stent graft in two patients. Echocardiography was used to determine AR severity grade preoperatively, during immediate post-operative period (within 7 days from operation) and at early follow-up. Results: In postoperative follow-up no patients died. Freedom from reoperation was 92.5% (5/65) and there were 2 patients (3%) reoperated due to early postoperative regurgitation. Two patients (3%) were operated two years following surgery, one of them due to severe aortic insufficiency and the other due to aortic root pseudoaneurysm. One patient’s postoperative recovery was complicated by ileus and a laparotomy was performed. A significant decrease in left ventricular end-diastolic diameter (LVEDd) was observed (preoperatively 60.01 mm/postoperatively 54.25 mm) with further decrease at early follow-up. At follow up one patient had major AR (he was reoperated) (AR 0 = 47, AR 1+= 13, AR 2+= 4). Conclusions: We have proved that AVRep is a good alternative for patients with aortic insufficiency and leads to LV reverse remodeling with comparable results in terms of LVEDd and left ventricular ejection fraction immediately postoperatively and at early follow up.

    Cardiologia Croatica
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    Remodeling technique of aortic valve repair with root replacement and extraaortic ring implantation

    Extended Abstract
    Issue11-12
    Published
    Pages383
    PDF via DOIhttps://doi.org/10.15836/ccar2018.383
    aortic valve insufficiency
    aortic root repair
    aortic valve repair

    Authors

    Igor RudežUniversity Hospital Dubrava, Zagreb, Croatia
    Josip Varvodić*University Hospital Dubrava, Zagreb, Croatia
    Davor BarićUniversity Hospital Dubrava, Zagreb, Croatia
    Daniel UnićUniversity Hospital Dubrava, Zagreb, Croatia
    Savica GjorgjievskaUniversity Hospital Dubrava, Zagreb, Croatia
    Marko KušurinUniversity Hospital Dubrava, Zagreb, Croatia
    Ivana JurinUniversity Hospital Dubrava, Zagreb, Croatia
    Nikola BuljUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Objective: Aortic valve replacement (AVR) is still the most commonly used therapeutic option for patients suffering from AR. Aortic valve repair (AVRep) is an attractive alternative method, since it avoids the risks of prosthesis-related complications. ( 1 , 2 ) We would like to present experience with the root remodeling, valve sparing technique with the extraaortic expansible ring. Patients and Methods: Between November 2014 and September 2018, a total of 65 patients (53.1±13.1 years; 18.5% female, EuroScore II of 0.48% to 11.17%) underwent AVRep; 8 due to isolated cusp malcoaptation and 57 with associated with aortic root dilatation. Reconstruction was done with the Coroneo Extraaortic Ring (27 (25-31)), and the Gelweave graft (28 (25-32)). Concomitant procedures included mitral valve reparation in 4 patients, with tricuspid valve reparation in two of them, coronary artery bypass graft in four patents. In two patients replacement of aortic arch was performed and placement of EVITA stent graft in two patients. Echocardiography was used to determine AR severity grade preoperatively, during immediate post-operative period (within 7 days from operation) and at early follow-up. Results: In postoperative follow-up no patients died. Freedom from reoperation was 92.5% (5/65) and there were 2 patients (3%) reoperated due to early postoperative regurgitation. Two patients (3%) were operated two years following surgery, one of them due to severe aortic insufficiency and the other due to aortic root pseudoaneurysm. One patient’s postoperative recovery was complicated by ileus and a laparotomy was performed. A significant decrease in left ventricular end-diastolic diameter (LVEDd) was observed (preoperatively 60.01 mm/postoperatively 54.25 mm) with further decrease at early follow-up. At follow up one patient had major AR (he was reoperated) (AR 0 = 47, AR 1+= 13, AR 2+= 4). Conclusions: We have proved that AVRep is a good alternative for patients with aortic insufficiency and leads to LV reverse remodeling with comparable results in terms of LVEDd and left ventricular ejection fraction immediately postoperatively and at early follow up.