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Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience.

Publication ,  Journal Article
Jawitz, OK; Raman, V; Anand, J; Bishawi, M; Voigt, SL; Doberne, J; Vekstein, AM; Weissler, EH; Turek, JW; Hughes, GC
Published in: Eur J Cardiothorac Surg
June 1, 2020

OBJECTIVES: Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports 'real-world' early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS: All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/- root +/- arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS: The median age was 58 years [interquartile range (IQR) 46-70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3-4+ in 37 (79%) patients. Forty-one (87%) patients had zero-trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5-20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10-13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS: Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

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Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

June 1, 2020

Volume

57

Issue

6

Start / End Page

1137 / 1144

Location

Germany

Related Subject Headings

  • Vascular Surgical Procedures
  • Treatment Outcome
  • Respiratory System
  • Middle Aged
  • Humans
  • Echocardiography, Transesophageal
  • Cardiac Valve Annuloplasty
  • Aortic Valve Insufficiency
  • Aortic Valve
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Jawitz, O. K., Raman, V., Anand, J., Bishawi, M., Voigt, S. L., Doberne, J., … Hughes, G. C. (2020). Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience. Eur J Cardiothorac Surg, 57(6), 1137–1144. https://doi.org/10.1093/ejcts/ezaa009
Jawitz, Oliver K., Vignesh Raman, Jatin Anand, Muath Bishawi, Soraya L. Voigt, Julie Doberne, Andrew M. Vekstein, E Hope Weissler, Joseph W. Turek, and G Chad Hughes. “Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience.Eur J Cardiothorac Surg 57, no. 6 (June 1, 2020): 1137–44. https://doi.org/10.1093/ejcts/ezaa009.
Jawitz OK, Raman V, Anand J, Bishawi M, Voigt SL, Doberne J, et al. Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience. Eur J Cardiothorac Surg. 2020 Jun 1;57(6):1137–44.
Jawitz, Oliver K., et al. “Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience.Eur J Cardiothorac Surg, vol. 57, no. 6, June 2020, pp. 1137–44. Pubmed, doi:10.1093/ejcts/ezaa009.
Jawitz OK, Raman V, Anand J, Bishawi M, Voigt SL, Doberne J, Vekstein AM, Weissler EH, Turek JW, Hughes GC. Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience. Eur J Cardiothorac Surg. 2020 Jun 1;57(6):1137–1144.
Journal cover image

Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

June 1, 2020

Volume

57

Issue

6

Start / End Page

1137 / 1144

Location

Germany

Related Subject Headings

  • Vascular Surgical Procedures
  • Treatment Outcome
  • Respiratory System
  • Middle Aged
  • Humans
  • Echocardiography, Transesophageal
  • Cardiac Valve Annuloplasty
  • Aortic Valve Insufficiency
  • Aortic Valve
  • 3201 Cardiovascular medicine and haematology