Mazzitelli, Domenico, Pfeiffer, Steffen, Rankin, J. Scott, Fischlein, Theodor, Choi, Yeong-Hoon, Wahlers, Thorsten, Noebauer, Christian, Schreiber, Christian and Lange, Ruediger (2015). A Regulated Trial of Bicuspid Aortic Valve Repair Supported by Geometric Ring Annuloplasty. Ann. Thorac. Surg., 99 (6). S. 2010 - 2017. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1552-6259

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Abstract

Background. Annular stabilization is important during bicuspid aortic valve (BAV) repair to obtain the best long-term results. This report describes the early outcomes of a novel bicuspid annuloplasty ring for this purpose. Methods. Under regulatory supervision (NCT02071849), a geometric bicuspid annuloplasty ring was used during valve repair in 16 patients. Three patients had Sievers type 0 valves, 11 had Sievers type 1, and 2 had Sievers type 2. Thirteen patients had left-/right-coronary cusp fusion, 1 had right-/noncoronary cusp fusion, and 2 had both. Moderate to severe aortic insufficiency (AI) was present in 13 of 16 patients, and 3 had mild AI with aortic aneurysms. Ascending aortic aneurysms, root aneurysms, or both were replaced in 7 of 16 patients. The Dacron-covered titanium ring had circular base geometry and two outwardly flaring subcommissural posts positioned opposite on the circumference. The ring was implanted into the annulus beneath the valve, and then leaflet repair was performed. Results. Immediate postrepair echocardiograms showed grade 0 residual AI in all patients, with good cusp mobility and effective height, and satisfactory gradients. There were no in-hospital or late mortalities. Two patients experienced leaflet tears from long annular suture tails, requiring late valve replacement. After implementation of a lateral suture fixation technique, no more failures occurred. At a mean follow-up time of 9 months, the remaining 14 patients were in New York Heart Association class I, with predominant grade 0 AI. Conclusions. As a technique for BAV repair, internal ring annuloplasty produces major annular remodeling and stabilization. Annular reduction and reshaping to a 50/50% symmetric circular geometry facilitates leaflet repair and enhances cusp coaptation. Geometric ring annuloplasty could have useful applications in BAV repair. (C) 2015 by The Society of Thoracic Surgeons

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Mazzitelli, DomenicoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfeiffer, SteffenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rankin, J. ScottUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fischlein, TheodorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Choi, Yeong-HoonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wahlers, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Noebauer, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schreiber, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lange, RuedigerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-402320
DOI: 10.1016/j.athoracsur.2015.01.050
Journal or Publication Title: Ann. Thorac. Surg.
Volume: 99
Number: 6
Page Range: S. 2010 - 2017
Date: 2015
Publisher: ELSEVIER SCIENCE INC
Place of Publication: NEW YORK
ISSN: 1552-6259
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RECONSTRUCTION; REIMPLANTATION; PERICARDIUM; REPLACEMENT; DISEASEMultiple languages
Cardiac & Cardiovascular Systems; Respiratory System; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/40232

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