Aortic Root Remodeling Technique With External Ring Annuloplasty And Valve Sparing Root Replacement: How To Start And Initial Results
Igor Rudez, Josip Varvodic, Davor Baric, Daniel Unic, Robert Blazekovic, Savica Gjorgjievska.
University Hospital Dubrava, Zagreb, Croatia.
OBJECTIVE: Aortic valve replacement (AVR) is still the most commonly used therapeutic option for patients suffering from AR. Aortic valve repair (AVRep) is an attractive alternative method, since it avoids the risks of prosthesis-related complications. We would like to present our experience with the remodeling technique of valve sparing root replacement with external expanisble ring annuloplasty.
METHODS: Between November 2014 and December 2016, a total of 42 patients (52.5±11.5 years; 18.9% female, EuroScore II of 2.8%±0.46%) underwent AVRep, 7 due to isolated cusp malcoaptation and 35 with associated aortic root dilatation. Recontruction was done with the Coroneo Extraaortic Ring (27 (25-29)) and the Gelweave graft (28 (26-32)). Concomitant proceedures included MVrep in 3 patients with TVrep in two of them, CABG in two patents and replacement of aortic arch and placement of EVITA hybrid stent graft in two patients. Echocardiography was used to determine AR severity grade pre-operatively, intraoperatively and during immediate post-operative period (within 7 days from operation) and at early follow-up.
RESULTS: In postoperative followup no patients died. Freedom from reoperation was 93% (3/42) and there were 2 patients reoperated due to early postoperative regurgtation, and one because of early cardiac tamponade. A significant decrease in LV end-diastolic diameter was observed (LVEDD (60.3/53.3 mm) with further decrease at early follow-up. At follow up none of the patients had major AR (AR 0=32,AR 1+=8, AR 2+=2).
CONCLUSIONS: We have proved that this metod of aortic root reconstruction and aortic valve repair is a good alternative for patients with aortic insufficiency and leads to LV reverse remodeling with comparable results in terms of LVEDD and LVEF immediately post-operatively and at early follow up. <!--EndFragment-->
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