Unicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty.

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Congenital Heart Disease

Background:

• Unicuspid aortic valves (UAVs), a type of Sievers type 2 bicuspid aortic valve, present complex anatomical challenges for surgical repair.
• Characterized by major right-left coronary commissure fusion and minor right-noncoronary commissure fusion, UAVs often involve variable sinus sizes and leaflet deficiencies.
• Previous repair attempts have been hindered by these anatomical complexities, leading to suboptimal outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of a new aortic ring annuloplasty technique for repairing unicuspid aortic valves.
• To assess the impact of this repair method on valve hemodynamics, patient symptoms, and long-term outcomes.

Main Methods:

• Twenty patients with unicuspid aortic valves underwent surgical repair using a bicuspid annuloplasty ring at nine institutions.
• The technique involved commissurotomy of the minor fusion, placement of a ring to equalize annular circumferences, plication of the nonfused leaflet, and linear closure of the major fusion cleft.
• Surgical goals included achieving effective leaflet heights and lengths greater than 8 mm and equalized leaflet coaptation.

Main Results:

• The study included 20 patients (average age 22.3 years), with 60% symptomatic and 50% requiring aortic aneurysm resection.
• Pre-repair data showed a mean systolic gradient of 25.8 mm Hg and an aortic insufficiency grade of 2.9.
• Post-repair, the mean gradient decreased to 16.2 mm Hg, and aortic insufficiency improved to 0.1 (P < .001), with no mortality or major complications. All patients were asymptomatic at 11-month follow-up.

Conclusions:

• Aortic ring annuloplasty effectively reduces annular diameter and enhances leaflet coaptation in UAV repair.
• Commissurotomy of minor fusions and annular remodeling create a reproducible and simplified repair procedure.
• This technique offers a promising solution for unicuspid aortic valve repair, leading to significant hemodynamic improvement and excellent clinical outcomes.