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Baric D, Sliskovic N, Sestan G, Gjorgjievska S, Unic D, Kusurin M, Varvodic J, Safaric Oremus Z, Jurin I, Bulj N, Susnjar D, Rudez I. Aortic Valve Repair with External Annuloplasty in Bicuspid versus Tricuspid Aortic Valve Patients. J Cardiovasc Dev Dis 2024; 11:17. [PMID: 38248887 PMCID: PMC10816450 DOI: 10.3390/jcdd11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Surgical repair for regurgitant bicuspid aortic valve (BAV) is promising but underutilized due to perceived complexities and lack of long-term data. This study evaluated the efficacy of valve-sparing root remodeling (VSRR) or isolated valve repair combined with calibrated external ring annuloplasty in BAV versus tricuspid aortic valve (TAV) patients. All patients operated on for aortic regurgitation and/or aneurysm at our institution between 2014 and 2022 were included and entered into the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR). Patients with successful repair at index surgery (100% in the BAV group, 93% in the TAV group, p = 0.044) were included in a systemic follow-up with echocardiography at regular intervals. Among 132 patients, 58 were in the BAV (44%) and 74 in the TAV group (56%). There were no inter-group differences in preoperative patient characteristics, except BAV patients being significantly younger (47 ± 18 y vs. 60 ± 14 y, p < 0.001) and having narrower aortic roots at the level of sinuses (41 ± 6 mm vs. 46 ± 13 mm, p < 0.001) and sinotubular junctions (39 ± 10 mm vs. 42 ± 11, p = 0.032). No perioperative deaths were recorded. At four years, there was no significant difference in terms of overall survival (96.3% BAV vs. 97.2% TAV, p = 0.373), freedom from valve reintervention (85.2% BAV vs. 93.4% TAV, p = 0.905), and freedom from severe aortic regurgitation (94.1% BAV vs. 82.9% TAV, p = 0.222). Surgical repair of BAV combined with extra-aortic annuloplasty can be performed with low perioperative morbidity and mortality and excellent mid-term results which are comparable to TAV repair.
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Affiliation(s)
- Davor Baric
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Nikola Sliskovic
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Gloria Sestan
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Savica Gjorgjievska
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Marko Kusurin
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Josip Varvodic
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Zrinka Safaric Oremus
- Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Dubrava University Hospital, 10 000 Zagreb, Croatia;
| | - Ivana Jurin
- Department of Cardiovascular Diseases, Dubrava University Hospital, 10 000 Zagreb, Croatia;
| | - Nikola Bulj
- Department of Cardiology, University Hospital Centre “Sestre Milosrdnice”, 10 000 Zagreb, Croatia;
| | - Dubravka Susnjar
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Igor Rudez
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
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Noor MA, Benhassen LL, Kaspersen AE, Weiss MG, Hasenkam JM, Johansen P. Novel Expansible Aortic Annuloplasty Ring Exhibits Similar Characteristics as the Dacron Ring-an In Vitro Evaluation. J Cardiovasc Transl Res 2023; 16:1144-1152. [PMID: 37261643 PMCID: PMC10615915 DOI: 10.1007/s12265-023-10393-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/24/2023] [Indexed: 06/02/2023]
Abstract
An increasing body of research indicates that annular stability plays a key role for a successful aortic valve repair. The aim of this study was to evaluate and compare a novel open aortic annuloplasty ring (the A-ring) with the Dacron ring. Both rings were compared with native aortic roots in vitro. Eighteen aortic roots were included in the study and randomized into three groups: the native, Dacron, and A-ring group. The roots were evaluated in an in vitro physiologic pulsatile model simulating the left side of the heart. Aortic annulus diameters were significantly reduced both in the Dacron ring group (p = 0.003) and the A-ring group (p = 0.020) when compared with the native group. Both the Dacron ring and A-ring effectively downsized the aortic annulus diameter. The A-ring also displayed an ability to maintain aortic root distensibility during the cardiac cycle equally to the Dacron ring.
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Affiliation(s)
- Mariam Abdi Noor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark.
| | - Leila Louise Benhassen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Alexander Emil Kaspersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Marc Gjern Weiss
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - John Michael Hasenkam
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Johansen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
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Devine K, Augoustides JG. Aortic Valve Repair: The Evolving Frontiers of Aortic Annuloplasty. J Cardiothorac Vasc Anesth 2022; 36:3999-4000. [PMID: 35989242 DOI: 10.1053/j.jvca.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Katelyn Devine
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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