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Leaflet Dimensions as a Guide to Remodeling Annuloplasty During Aortic Valve Repair
Marek J Jasinski1, J Scott Rankin2, Domenico Mazzitelli3
149550 Department of Cardiac Surgery, Wroclaw Medical University, Poland.
Innovations (Philadelphia, Pa.)
|March 18, 2021
Summary
In chronic aortic insufficiency (AI), annular dilatation is common, necessitating aortic valve repair (AVr) with annuloplasty. Precise annular reduction, guided by leaflet size, ensures durable coaptation for effective AI treatment.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Aortic Valve Disease
Background:
- Chronic aortic insufficiency (AI) presents challenges in achieving durable valve repair due to poorly defined annular sizing requirements.
- Annular dilatation is a common finding in patients undergoing aortic valve repair (AVr).
Purpose of the Study:
- To evaluate the relationship between leaflet size and annular diameter for predicting adequate annular sizing in remodeling AVr for chronic AI.
- To establish a method for determining the required annular reduction in AVr.
Main Methods:
- Seventy-four patients with chronic AI underwent AVr with ring annuloplasty and leaflet reconstruction.
- Intraoperative leaflet free-edge length (FEL) was measured to predict a "normal" annular diameter using the formula: Required "normal" diameter = FEL/1.5.
- Predicted "normal" annular diameters were compared with pathologic diameters and correlated with patient demographics.
Main Results:
- All patients exhibited annular dilatation, with pathologic diameters averaging 26.6 mm and predicted "normal" diameters averaging 21.7 mm.
- Annular diameters were significantly larger in men but showed no correlation with age.
- Body surface area (BSA) correlated with both diameters, though with considerable variability.
Conclusions:
- Chronic AI consistently involves annular dilatation, indicating the necessity of annuloplasty in most AVr procedures.
- Accurate and precise annular reduction, determined by leaflet size, is crucial for successful AVr and durable coaptation.
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