New Flexible Internal Annular Fixation Rings For Tricuspid Aortic Valves
Kohei Abe, Kohei Kawazoe, Hiroyasu Misumi, Manabu Yamasaki, Kunihiko Yoshino.
St. Luke's international hospital, Tokyo, Japan.
Background-There is a long history of correcting aortic annulus, however, there is still no device commercially available. Here we have invented the new method to use an ePTFE graft with the support of metallic ring during implantation only from inside of aorta without any dissection surrounding aortic annulus. Methods-18 through 24mm aortic annular rings are composed with GoreTex tubed grafts (W. L. Gore & Associates, Arizona, USA) and metallic rings. After cutting the graft circumferentially with 5mm thickness, the graft was compressed manually to decrease its thickness. Then the metallic ring corresponds to each graft size is inserted into the graft. A metallic ring is fixed to the graft with one 4-0 monofilament suture by using 6 holes and the side trench on the metallic ring. A proper size of graft is chosen and the annuloplasty ring. A row of 4-0 double-needle braded sutures with ePTFE spaghettis are sewn from aortic side into left ventricular outflow tract(LVOT) with horizontal mattress fashion. After all the sutures around the annulus being placed, all the sutures are tied down and the metallic ring is removed. Repair of leaflets is performed if necessary. Results- Ttotal 9 patients with tricuspid aortic valve have received this procedure since January 2015. Utilized sizes of SCA were 20mm(n=3), 22mm(n=5), and 24mm(n=2). Repairs for aortic leaflets were done in 6 patients (6 central plications). Concomitant procedures were total aortic arch replacement(n=2), mitral valve repair(n=2), tricuspid valve repair(n=1), and CABG(n=2). There were no hospital deaths, and no major morbidities. All the patients are being controlled equal to or less than mild AR during the mean follow up of 13 months. Postoperative echocardiograms showed excellent peak pressure gradients compared to preoperative echocardiogram. Postoperative cardiac CT scan was done in 6 cases. The discrepancies between utilized ring size and postoperative annular size were less than 1mm in diameter in all cases. Conclusions-This new flexible ring is very simple to fix an aortic annulus from inside. Early results revealed excellent control of aortic regurgitation with the projected annular size. Further investigations should be needed to ensure the effectiveness of the ring. 
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