Deep circumferential annuloplasty as an adjunct to repair regurgitant bicuspid aortic valves with a dilated annulus

The Journal of Thoracic and Cardiovascular Surgery

Stefano Mastrobuoni¹  Omar Nawaytou² 

[1] Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada;Division of Cardiovascular Surgery, University Hospital Saint-Luc, Brussels, Belgium

关键词: bicuspid aortic valve;    aortic valve repair;    annuloplasty;    valve sparing root replacement;   

DOI  :  10.1016/j.jtcvs.2018.03.110

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

BackgroundFailure to address the functional aortic annulus during bicuspid aortic valve (BAV) repair has led to early repair failures. The pathology of regurgitant BAV involves annular dilatation, which is more pronounced anteriorly and deep toward the muscular interventricular septum. In this study, we assessed the results of BAV repair using a strategy of deep circumferential annular support involving the septum in patients with a dilated annulus (>26 mm) and moderate to severe aortic regurgitation (AR).MethodsBetween February 1999 and June 2015, 100 patients with regurgitant (≥2+) BAV and a dilated ventriculoaortic junction (VAJ) (≥26 mm) underwent repair with an adjunctive circumferential annuloplasty (reimplantation procedure or ring). External root dissection to accommodate the annuloplasty was carried deep onto the anterior aspect of the interventricular septum. Follow up was complete in 96 patients, with a median follow-up of 31 months and a total of 362 patient-years. Cox regression analysis was used to predict recurrence of AR.ResultsThe mean VAJ diameter was 30 ± 4 mm. Seventy-nine patients exhibited delayed prolapse of the anterior leaflet (conjoined right and left cusps in Siever type 1 or anterior cusp in Siever type 0), and 93 patients underwent reimplantation. In the entire study group, there were no in-hospital deaths, and only 1 patient had 2+ AR on discharge. There was 1 late noncardiac death. At 8 years, freedom from AR ≥2+ was 96.4% and freedom from reoperation was 96.8%. Higher preoperative AR grade, small graft size, and use of a ring were predictive of recurrent AR.ConclusionsRegurgitant BAVs with a dilated annulus display anterior cusp prolapse toward the septum. A deep circumferential annuloplasty may help maintain repair durability.

【 授权许可】

Unknown