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Unicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty.

Publication ,  Journal Article
Si, M-S; Conte, JV; Romano, JC; Romano, MA; Andersen, ND; Gerdisch, MW; Kupferschmid, JP; Fiore, AC; Bakhos, M; Bonilla, JJ; Burke, JR ...
Published in: Ann Thorac Surg
April 2021

BACKGROUND: Unicuspid aortic valves (Sievers type 2 bicuspid) are characterized by major fusion and clefting of the right-left coronary commissure, and minor fusion of the right-noncoronary commissure. Repair has been difficult because of two fusions, variable relative sinus sizes, and peripheral leaflet deficiencies or tears after balloon valvuloplasty. METHODS: Twenty unicuspid aortic valves patients underwent valve repair in nine institutions. Right-left major fusion and right-noncoronary minor fusion occurred in 17 of 20 (85%). Commissurotomy was performed on the minor fusion, and a bicuspid annuloplasty ring with circular base geometry and two 180-degree subcommissural posts was sutured beneath the annulus, equalizing the annular circumferences of the fused and nonfused cusps. The nonfused leaflet was plicated, and the cleft in the major fusion was closed linearly until leaflet effective heights and lengths became greater than 8 mm and equal, respectively. RESULTS: Average age (mean ± SD) was 22.3 ± 12.3 years (range, 13 to 58), 12 of 20 (60%) were symptomatic, 10 of 20 (50%) required aortic aneurysm resection. Pre-repair hemodynamic data included mean systolic valve gradient 25.8 ± 12.9 mm Hg, aortic insufficiency grade 2.9 ± 1.2, and annular diameter 24.7 ± 3.3 mm. No mortality or major complications occurred. Post-repair annular (ring) size was 20.5 ± 1.3 mm, mean gradient fell to 16.2 ± 5.9 mm Hg, and aortic insufficiency grade decreased to 0.1 ± 0.3 (P < .001). At an average follow-up of 11 months (range, 1 to 22), all 20 patients were asymptomatic and had returned to full activity. CONCLUSIONS: Aortic ring annuloplasty reduced annular diameter effectively, recruiting more leaflet to midline coaptation. Minor fusion commissurotomy and annular remodeling to 180-degree commissures converted UAV repair to a simple and reproducible procedure.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

April 2021

Volume

111

Issue

4

Start / End Page

1359 / 1366

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Respiratory System
  • Prosthesis Design
  • Middle Aged
  • Male
  • Humans
  • Heart Valve Prosthesis
  • Female
  • Child
  • Cardiac Valve Annuloplasty
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Si, M.-S., Conte, J. V., Romano, J. C., Romano, M. A., Andersen, N. D., Gerdisch, M. W., … Turek, J. W. (2021). Unicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty. Ann Thorac Surg, 111(4), 1359–1366. https://doi.org/10.1016/j.athoracsur.2020.04.147
Si, Ming-Sing, John V. Conte, Jennifer C. Romano, Matthew A. Romano, Nicholas D. Andersen, Marc W. Gerdisch, John P. Kupferschmid, et al. “Unicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty.Ann Thorac Surg 111, no. 4 (April 2021): 1359–66. https://doi.org/10.1016/j.athoracsur.2020.04.147.
Si M-S, Conte JV, Romano JC, Romano MA, Andersen ND, Gerdisch MW, et al. Unicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty. Ann Thorac Surg. 2021 Apr;111(4):1359–66.
Si, Ming-Sing, et al. “Unicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty.Ann Thorac Surg, vol. 111, no. 4, Apr. 2021, pp. 1359–66. Pubmed, doi:10.1016/j.athoracsur.2020.04.147.
Si M-S, Conte JV, Romano JC, Romano MA, Andersen ND, Gerdisch MW, Kupferschmid JP, Fiore AC, Bakhos M, Bonilla JJ, Burke JR, Rankin JS, Wei LM, Badhwar V, Turek JW. Unicuspid Aortic Valve Repair Using Geometric Ring Annuloplasty. Ann Thorac Surg. 2021 Apr;111(4):1359–1366.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

April 2021

Volume

111

Issue

4

Start / End Page

1359 / 1366

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Respiratory System
  • Prosthesis Design
  • Middle Aged
  • Male
  • Humans
  • Heart Valve Prosthesis
  • Female
  • Child
  • Cardiac Valve Annuloplasty