Remodeling root repair with an external aortic ring annuloplasty

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Aortic Root Reconstruction

Background:

• Dilated aortic annulus is a risk factor for valve-sparing root replacement failure.
• Aortic annuloplasty aims to reduce annulus diameter and improve leaflet coaptation.
• External aortic ring annuloplasty is an adjunct to remodeling for aortic valve repair.

Purpose of the Study:

• To evaluate the outcomes of valve-sparing root replacement using remodeling combined with external aortic ring annuloplasty.
• To assess the impact of standardized techniques on valve repair durability.

Main Methods:

• Retrospective analysis of 177 patients undergoing aortic valve repair with remodeling and external aortic ring annuloplasty.
• Data collected from the Aortic Valve repair InternATiOnal Registry.
• Comparison of outcomes before and after the systematic implementation of calibrated expansible ring annuloplasty and cusp effective height assessment.

Main Results:

• Overall 7-year freedom from reoperation was 89.5%.
• Systematic use of calibrated expansible ring annuloplasty and cusp effective height assessment significantly improved 7-year freedom from reoperation (99.1%), severe aortic insufficiency (100%), and major adverse events (96.3%).
• Calibrated annuloplasty and effective height assessment were protective factors against reoperation.

Conclusions:

• Standardization of aortic root repair with calibrated expansible aortic ring annuloplasty and cusp effective height assessment improves valve repair outcomes.
• This approach enhances the durability of valve-sparing root replacement.
• The technique is effective for both tricuspid and bicuspid aortic valves.