An external open ring for isolated aortic valve repair

Experience with repair of isolated aortic insufficiency (AI) is increasing, encouraged by the results of valve-sparing procedures. Current techniques associate the treatment of cusp prolapse with the reduction of the almost constantly dilated aortic annular base diameter. Although few series provided satisfying mid-term results in selected patients, the lack of standardization limits their widespread use. We developed a standardized aortic valve repair procedure for isolated AI (sinuses of Valsalva ≪40 mm), combining cusp repair with a subvalvular external aortic ring annuloplasty. Alignment of cusp free edges and resuspension of the cusp effective height are performed prior to implantation of the external subvalvular ring. The prosthetic ring is of an open configuration to allow its placement externally to the aorta and below the coronary arteries without detaching them from the aortic wall. Ring size is undersized by one size relative to annular base inner diameter measured intraoperatively. The aim of the ring is to reduce the dilated aortic annular base diameter while increasing coaptation height.