OBJECTIVES: Aortic valve (AV) insufficiency with normal root and ascending aorta is most frequently treated by valve replacement with significant prosthetic-related complications and reduced life expectancy. We compared the outcomes of a new standardized isolated AV repair approach using an external aortic annuloplasty ring at the subvalvular level (single ring annuloplasty) and the role of an additional supravalvular ring at the sinotubular junction (double ring annuloplasty). METHODS: Single centre data were collected from the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) between 2003 and 2017. A total of 93 patients (56 single ring and 37 double ring) underwent isolated AV repair. RESULTS: The overall 30-day mortality rate and the need for a permanent pacemaker were 1% and 2%, respectively. The overall survival rate at 6 years was similar for sex- and age-matched members of the general population (89% vs 95%; P = 0.1) and did not differ between the double and single ring groups (82% vs 93%; P = 0.4) at 6 years. There were no thromboembolic or bleeding events in the entire cohort. However, at 6 years, the cumulative incidence of valve-related reintervention was 26% in the single ring annuloplasty group compared to 3% in the double ring annuloplasty (P = 0.02) group. Similarly, at 6 years, the cumulative incidence of moderate-to-severe (>2) aortic insufficiency was 30% in the single ring annuloplasty group compared to 0% in the double ring annuloplasty group (P = 0.007). CONCLUSIONS: Standardized AV repair with external ring annuloplasty has a survival rate similar to that of the general population. The additional stabilization of the sinotubular junction with a second supravalvular ring (double ring annuloplasty) is associated with better outcomes compared to single subvalvular annuloplasty. It can be considered as a first line intervention for patients with isolated aortic insufficiency and pliable leaflets.

• MeSH
• Cardiac Valve Annuloplasty * adverse effects   MeSH
• Aortic Aneurysm * MeSH
• Aortic Valve diagnostic imaging   surgery   MeSH
• Aortic Valve Insufficiency * surgery   MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Heart Valve Prosthesis * MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Aged, 80 and over MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: Although the remodeling technique provides the most dynamic valve-sparing root replacement, a dilated annulus (>25 mm) is a risk factor for failure. Aortic annuloplasty aims to reduce the annulus diameter, thus increasing coaptation height to protect the repair. The results of 177 patients with remodeling and external aortic ring annuloplasty were studied. METHODS: Data were collected from the Aortic Valve repair InternATiOnal Registry. Preoperative aortic insufficiency grade 3 or greater was present in 79 patients (44.7%). The valve was bicuspid in 59 patients (33.3%). External annuloplasty was performed through a homemade Dacron ring (56) or a dedicated expansible aortic ring (121). RESULTS: Thirty-day mortality was 2.9% (5). Mean follow-up was 41.1 ± 36.4 months. For the whole series, freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, aortic insufficiency grade 2 or greater, and major adverse valve-related events were 89.5%, 90.5%, 77.4%, and 86.6% at 7 years, respectively, with similar results for tricuspid and bicuspid valves. Since 2007, systematic use of calibrated expansible ring annuloplasty, followed 1 year later by systematic cusp effective height assessment, significantly increased 7-year freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, and major adverse valve-related events up to 99.1% ± 0.9% (P = .017), 100% (P = .026), and 96.3% ± 1.8% (P = .035), respectively, whereas freedom from aortic insufficiency grade 2 or greater remained unaffected (78.1% ± 7.6%). Calibrated annuloplasty and effective height assessment were identified as protective factors from reoperation: hazard ratio, 0.13; 95% confidence interval, 0.02-1.06; P = .057 and hazard ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .044, respectively. CONCLUSIONS: The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp effective height assessment improves valve repair outcomes.

• MeSH
• Cardiac Valve Annuloplasty adverse effects   instrumentation   mortality   MeSH
• Aorta diagnostic imaging   physiopathology   surgery   MeSH
• Aortic Aneurysm diagnostic imaging   mortality   physiopathology   surgery   MeSH
• Aortic Valve abnormalities   diagnostic imaging   physiopathology   surgery   MeSH
• Aortic Valve Insufficiency diagnostic imaging   mortality   physiopathology   surgery   MeSH
• Echocardiography, Doppler, Color MeSH
• Time Factors MeSH
• Blood Vessel Prosthesis * MeSH
• Blood Vessel Prosthesis Implantation adverse effects   instrumentation   mortality   MeSH
• Heart Valve Prosthesis Implantation adverse effects   instrumentation   mortality   MeSH
• Progression-Free Survival MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Heart Valve Diseases diagnostic imaging   mortality   physiopathology   surgery   MeSH
• Recovery of Function MeSH
• Polyethylene Terephthalates MeSH
• Postoperative Complications etiology   MeSH
• Prosthesis Design MeSH
• Registries MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Heart Valve Prosthesis * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Video-Audio Media MeSH
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Geographicals
• France MeSH

• MeSH
• Aortic Valve Insufficiency MeSH
• Echocardiography MeSH
• Cardiac Surgical Procedures MeSH
• Heart Valve Prosthesis MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• angiologie
• NML Publication type
• kolektivní monografie

Zcela unikátní publikace s 280, často složenými originálními obrázky doc. MUDr. Pavla Žáčka! Kniha je důležitá nejen pro kardiology, kardiochirurgy a internisty, ale i echokardiografisty a další odborníky zobrazovacích metod i všechny, kteří o nemocné s aortální nedomykavostí v praxi pečují.

• Keywords
• Chirurgie, ortopedie, traumatologie, Interna, Kardiologie, angiologie,
• MeSH
• Aortic Valve Insufficiency MeSH
• Echocardiography MeSH
• Cardiac Surgical Procedures MeSH
• Heart Valve Prosthesis MeSH

• NML Fields
• angiologie

• Keywords
• aortální kořen,
• MeSH
• Aortic Valve anatomy & histology   MeSH
• Echocardiography methods   MeSH
• Cardiology methods   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH