Aortic annuloplasty has demonstrated to be a protective factor in valve-sparing root
replacement and aortic valve repair. Both reimplantation for aortic root aneurysms
and external ring annuloplasty for isolated aortic regurgitation have demonstrated
good long-term results. The aim of this anatomical study is to compare aortic reimplantation
with Valsalva graft with aortic external ring annuloplasty in bicuspid aortic valves,
analyzing their morphological features with CT scan. We selected 56 patients with
bicuspid aortic valve who underwent reimplantation procedure with Valsalva graft or
external ring annuloplasty; after propensity-matching, 2 homogeneous groups of 10
patients each were obtained. Through multiplanar ECG-gated CT-Scan reconstructions,
pre- and postoperative, aortic annular, and valve geometrical characteristics were
compared (diameters, perimeter, area and ellipticity index for the annulus; effective
height, coaptation length and commissural height for the valve). Aortic root volume
was also analyzed. Postoperative comparison of the two groups showed similar geometric
features of the aortic annulus in terms of major and minor diameters, perimeter, area
and ellipticity index. Analysis of valve's parameters showed similar results in terms
of effective height and coaptation length (respectively 10.9 ± 2.1 mm and 7.5 ± 1.9
mm in External Ring group and 10.1 ± 2.0 mm and 7.6 ± 1.6 mm in the Reimplantation
group). Both techniques achieve an efficient annuloplasty with similar anatomical
results on bicuspid the aortic valves. The stability of these results needs to be
confirmed by long-term clinical and echocardiographic follow-up.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
A (area), AR (aortic regurgitation), AVS (aortic valve sparing), BAV (bicuspid aortic valve), BSA (body surface area), cL (coaptation length), CO (commissural orientation), CT (computed tomography), ECG (electrocardiogram), eH (effective height), EI (ellipticity index), FAA (functional aortic annulus), md (minor diameter), MD (major diameter), nFC (non-fused cusp), P (perimeter), STJ (sino-tubular junction), TAV (tricuspid aortic valve), VBR (virtual basal ring), VSRR (valve sparing root replacement)To read this article in full you will need to make a payment
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REFERENCES
- Aortic prosthetic ring annuloplasty: A useful adjunct to a standardized aortic valve-sparing procedure?.Eur J Cardiothorac Surg. 2006; 29: 537-544
- The role of annular dimension and annuloplasty in tricuspid aortic valve repair.Eur J Cardiothorac Surg. 2016; 49: 428-438
- Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair.J Thorac Cardiovasc Surg. 2012; 143: 1389-1395
- Early results with annular support in reconstruction of the bicuspid aortic valve.J Thorac Cardiovasc Surg. 2013; 145: S30-S34
- Effect of annulus dimension and annuloplasty on bicuspid aortic valve repair.Eur J Cardiothorac Surg. 2013; 44: 316-323
- Long-term results of the valve reimplantation technique using a graft with sinuses.J Thorac Cardiovasc Surg. 2016 Jan; 151: 112-119
- A quarter of century of experience with aortic valve-sparing operations.J Thorac Cardiovasc Surg. 2014 Sep; 148: 872-879
- Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation.J Thorac Cardiovasc Surg. 2019 Jul; 158: 14-23
- Long-term results of external aortic ring annuloplasty for aortic valve repair.Eur J Cardiothorac Surg. 2016; 50: 350-360
- 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC).Eur Heart J. 2014 Nov 1; 35: 2873-2926
- 2017 ESC/EACTS guidelines for the management of valvular heart disease.Eur Heart J. 2017 Sep 21; 38: 2739-2791
- The ascending aorta with bicuspid aortic valve: A phenotypic classification with potential prognostic significance.Eur J Cardio-Thorac Surg. 2014; 46: 240-247
- The American Association for Thoracic Surgery Consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version.J Thorac Cardiovasc Surg. 2018 August; 156: e41-e74
- A new aortic Dacron conduit for surgical treatment of aortic root pathology.Ital Heart J. 2000; 1: 457-463
- Morphological modification of the aortic annulus in tricuspid and bicuspid valves after aortic valve reimplantation: an electrocardiography-gated computed tomography study.Eur J Cardiothorac Surg. 2019; 56: 778-784
- A direct correlation between commissural orientation and annular shape in bicuspid aortic valves: a new anatomical and computed tomography classification.Interact Cardiovasc Thorac Surg. 2020 May 1; 30: 666-670
- A new approach to the assessment of aortic cusp geometry.J Thorac Cardiovasc Surg. 2006; 132: 436-438
- Aortic root numeric model: Correlation between intraoperative effective height and diastolic coaptation.J Thorac Cardiovasc Surg. 2013; 145: 303-304
- Aortic root numeric model: Annulus diameter prediction of effective height and coaptation in post-aortic valve repair.J Thorac Cardiovasc Surg. 2013; 145: 406-411
- Repair of bicuspid aortic valve.Operative Techniques in Thoracic and Cardiovasc Surg. 2018; 22: 91-109
- Concepts of bicuspid aortic valve repair – A review.Ann Thorac Surg. 2020 Apr; 109: 999-1006
- State-of-art bicuspid aortic valve repair in 2020.Prog Cardiovasc Dis. 2020; 63: 457-464
- Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection.Heart. 2020; 106: 892-897
- Long-term results of differentiated anatomic reconstruction of bicuspid aortic valves.JAMA. 2020; (September 16): E1-E8
- Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification.Eur J Cardiothorac Surg. 2019; (ezz033)
Article info
Publication history
Published online: June 30, 2021
Footnotes
Funding: None declared.
Conflict of Interest: As inventor of the Valsalva graft described in the manuscript, Prof. De Paulis has received in the past royalties from Terumo Aortic. All other authors have nothing to disclose regarding commercial support.
The study was approved by internal ethical Committee and all patients consented to participate (No. 2020/01 on January 15th 2020).
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- Commentary: Is Simpler Better?Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewIt is critical to understand the anatomy of the aortic root in aortic valve repair for aortic insufficiency. There are ten structure in the aortic root: One anatomical crown-shaped aortic annulus, 2 coronary ostia, 3 aortic sinuses and/or 3 cusps and/or 3 interleaflet triangles, and 4 rings: virtual basal ring (functional aortic annulus), ventriculo-aortic junction (VAJ), ring of the aortic sinuses (largest diameter of the aortic root), and sinotubular junction (STJ). Among the ten structures, 3 structures are critical for the competency of aortic valve (AV), including the functional aortic annulus (basal ring), the cusps and the STJ.
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