6533b859fe1ef96bd12b6e3c

RESEARCH PRODUCT

Functional annulus remodelling using a prosthetic ring in tricuspid aortic valve repair: mid-term results

Massimo SalardinoGiuseppe NassoKhalil FattouchFrancesco GuccionePietro DioguardiGiuseppe SpezialeSebastiano CastrovinciGiacomo MuranaGiuseppe Bianco

subject

MaleAortic valveTime Factorsmedicine.medical_treatmentKaplan-Meier EstimateAortic valve repairRisk FactorsRecurrenceAortic Valve AnnulusAortic valveHospital MortalityUltrasonographyAged 80 and overHeart Valve Prosthesis ImplantationAnnulus (mycology)Sinotubular JunctionMiddle AgedCardiac Valve AnnuloplastyTreatment Outcomemedicine.anatomical_structureEchocardiographyHeart Valve ProsthesisReplantationReplantationcardiovascular systemCardiologyFemaleCardiology and Cardiovascular MedicineHumanAdultHeart Defects CongenitalPulmonary and Respiratory Medicinemedicine.medical_specialtyTime FactorAortic Valve InsufficiencyProsthesis DesignCardiac Valve AnnuloplastyDisease-Free SurvivalRisk analysiInternal medicinemedicineHumansSurvival rateStatisticAgedbusiness.industryPatient SelectionRisk FactorSettore MED/23 - Chirurgia CardiacaOriginal ArticlesSurgeryHeart Valve ProsthesiSurgerybusinessRepair

description

OBJECTIVES: The functional aortic valve annulus (FAVA) is a complex unit with proximal (aorto-ventricular junction) and distal (sinotubular junction) components. The aim of our study was to evaluate the impact of the total FAVA remodelling, using a prosthetic ring, on mid-term clinical and echocardiographic-RESULTS:-after aortic valve repair. METHODS: Since February 2003, 250 patients with tricuspid aortic valve insufficiency (AI) underwent aortic valve repair. FAVA dilatation was treated by prosthetic ring in 52 patients, by isolated subcommissural plasty in 62, by subcommissural plasty plus ascending aortic replacement in 57 and by David's reimplantation procedure in 79. Survival rate and freedom from recurrent AI greater than or equal to moderate were evaluated by Kaplan-Meier. RESULTS: Overall late survival was 90.4%. Late cardiac-related deaths occurred in 15 patients. At follow-up, 36 (16%) patients had recurrent AI greater than or equal to moderate because of cusp reprolapse and/or FAVA redilatation. Freedom from recurrent AI was significantly higher for patients who underwent David's procedure or FAVA remodelling by prosthetic ring than those who underwent isolated subcommissural plasty (P < 0.01) or subcommissural plasty plus ascending aortic replacement (P = 0.02). There was no statistical difference between David's procedure and prosthetic ring annuloplasty (P = 0.26).CONCLUSIONFAVA remodelling using a prosthetic ring is a safe procedure in aortic valve repair surgery thanks to long-term annulus stabilization and it is a pliable alternative to David's procedure in selected patients. This technique may be used in all patients with slight root dilatation to avoid aggressive root reimplantation. We also recommended total FAVA annuloplasty in all patients who underwent aortic valve repair to improve long-term repair-RESULTS:. © 2013 The Author.

yearjournalcountryeditionlanguage
2013-09-24Interactive CardioVascular and Thoracic Surgery
https://doi.org/10.1093/icvts/ivt410