Authors

• Igor Rudež — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-7735-6721
• Josip Varvodić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6602-699X
• Davor Barić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5955-0275
• Daniel Unić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2740-4067
• Robert Blažeković — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-7125-361X
• Mislav Planinc — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-9833-832X
• Marko Kušurin — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-5690-9924
• Michael Markin — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0003-2478-9192
• Savica Gjorgjievska — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0002-4304-1852
• Željko Sutlić — University Hospital Dubrava, Zagreb, Croatia — ORCID: 0000-0001-6926-9436

Keywords

valve reconstruction, aortic insufficiency, aortic root reconstruction

DOI

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 our experience with the Yacoub root remodeling, valve sparing technique with the extraaortic expansible ring. **Methods:** Between November 2014 and September 2016, a total of 37 patients (52.5±11.5 years; 18.9% female, EuroScore II of 2.8% to 0.46%) underwent AVRep, 6 due to isolated cusp malcoaptation and 31 with associated with aortic root dilatation. Reconstruction was done with the Coroneo Extraaortic Ring (27 (25-29)), and the Gelweave graft (28 (26-32)). Concomitant procedures included MVRep in 3 patients with TVrep in two of them, CABG in two patents and replacement of aortic arch and placement of EVITA stent graft in two patients. Echocardiography was used to determine AR severity grade pre-operatively, 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% (3/37) and there were 2 patients reoperated due to early postoperative regurgtation, and one because of early cardiac tamponade. A significant decrease in LV end-diastolic diameter was observed (LVEDD) (60.3/53.3 mm) with further decrease at early follow-up. At follow up none of the patients had major AR (0±0.5, AR0=28, AR1+=7, AR2+=2). **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 LVEF immediately post-operatively and at early follow up.

Literature

1. Lansac E, Di Centa I, Vojacek J, Nijs J, Hlubocky J, Mecozzi G, et al. Valve sparing root replacement: the remodeling technique with external ring annuloplasty. Ann Cardiothorac Surg. 2013;2(1):117–23. https://doi.org/10.3978/j.issn.2225-319X.2013.01.15
2. Lansac E, Di Centa I, Raoux F, Bulman-Fleming N, Ranga A, Abed A, et al. An expansible aortic ring for a physiological approach to conservative aortic valve surgery. J Thorac Cardiovasc Surg. 2009;138(3):718–24. https://doi.org/10.1016/j.jtcvs.2009.05.024