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.

• Klíčová slova
• Aortic insufficiency, Bicuspid, External ring annuloplasty, Valve repair,
• MeSH
• anuloplastika srdeční chlopně * škodlivé účinky   MeSH
• aortální aneurysma * MeSH
• aortální chlopeň diagnostické zobrazování   chirurgie   MeSH
• aortální insuficience * chirurgie   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• srdeční chlopně umělé * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Current guidelines recommend root replacement when diameter of the sinuses of Valsalva are superior to 45 mm particularly for bicuspid valve. However, in case of tubular aorta aneurysms with moderate root dilatation (40-45 mm diameter), the approach is still debated regarding the increased risk of coronary reimplantation. We present a modified hemi-remodeling aortic repair technique that includes the replacement of the noncoronary sinus, ascending aorta, and valve repair with external ring annuloplasty in patients with bicuspid aortic valve (BAV) and moderately dilated aortic root. METHODS: Between 2003 and 2017, 18 patients presenting with left-right BAV and an aortic root diameter at 42.3+/-3.3 mm underwent hemi-root and ascending aorta replacement and aortic valve repair with external annuloplasty. RESULTS: Postoperatively, 16 (88.9%) had no aortic insufficiency (AI) and 2 (11.1%) had grade I AI, no patients had grade III or grade IV AI. Overall survival and freedom from grade II AI at 4 years and freedom from aortic valve-related reoperation were 100%. CONCLUSION: The standardized modified hemi-remodeling technique we present is a safe and reproducible procedure, with satisfactory durability at follow-up. This technique represents an interesting alternative to full valve sparing root replacement, as it avoids the operative risk of coronary reimplantation, allows shorter cross-clamping time and a better exposition on the valve for a symmetrical repair, placing the commissure at 180°, compared with valve sparing root replacement.

• Klíčová slova
• aneurysm of the ascending aorta, annuloplasty, aortic valve repair, bicuspid aortic valve, valve sparing root replacement,
• MeSH
• anuloplastika srdeční chlopně metody   MeSH
• aortální chlopeň abnormality   chirurgie   MeSH
• bikuspidální aortální chlopeň MeSH
• nemoci srdečních chlopní chirurgie   MeSH
• Publikační typ
• časopisecké články 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.

• Klíčová slova
• aortic annuloplasty, aortic ring, effective height, remodeling, valve repair, valve sparing,
• MeSH
• anuloplastika srdeční chlopně škodlivé účinky   přístrojové vybavení   mortalita   MeSH
• aorta diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• aortální aneurysma diagnostické zobrazování   mortalita   patofyziologie   chirurgie   MeSH
• aortální chlopeň abnormality   diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• aortální insuficience diagnostické zobrazování   mortalita   patofyziologie   chirurgie   MeSH
• barevná dopplerovská echokardiografie MeSH
• bikuspidální aortální chlopeň MeSH
• časové faktory MeSH
• cévní protézy * MeSH
• cévy - implantace protéz škodlivé účinky   přístrojové vybavení   mortalita   MeSH
• chirurgická náhrada chlopně škodlivé účinky   přístrojové vybavení   mortalita   MeSH
• doba přežití bez progrese choroby MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nemoci srdečních chlopní diagnostické zobrazování   mortalita   patofyziologie   chirurgie   MeSH
• obnova funkce MeSH
• polyethylentereftaláty MeSH
• pooperační komplikace etiologie   MeSH
• protézy - design MeSH
• registrace MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční chlopně umělé * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• audiovizuální média MeSH
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• Geografické názvy
• Francie MeSH
• Názvy látek
• polyethylentereftaláty MeSH

OBJECTIVES: This study assessed the safety and efficacy of an internal geometric annuloplasty ring in a regulatory trial of aortic valve reconstruction (ClinicalTrials.gov Identifier: NCT01400841). METHODS: Sixty-five patients with predominant moderate-to-severe trileaflet aortic insufficiency (AI) underwent aortic valve repair with an average age of 63 ± 13 years (mean ± SD). All had initial implantation of an internal aortic annuloplasty ring to correct annular dilatation and facilitate leaflet reconstruction. Leaflet plication was performed for prolapse in 80% of patients, and more complex leaflet procedures, usually employing autologous pericardium, were required in 22%. Ascending aortic and/or root aneurysms were replaced in 62%. RESULTS: Follow-up was for a maximum of 3 years and a mean of 2 years. No in-hospital operative mortalities, major complications or early or late valve-related events occurred. The annular diameter before repair was 26.5 ± 2.3 mm, and the average ring diameter used was 21.5 ± 1.6 mm. The preoperative AI grade (0-4) was 2.9 ± 0.8 and improved after repair to 0.6 ± 0.7 (P < 0.0001), as did the NYHA class. The mean valve gradient was 8.6 ± 4.3 mmHg, and at 3 years, the Kaplan-Meier survival rate was 95%, with no valve-related mortality. Over the 3 years, aortic valve replacement was required in 7 patients (10.8%) for reasons usually related to surgical technique. Most repair failures occurred early, and results stabilized after 6 months. No structural complications of the rings were observed. CONCLUSIONS: Geometric ring annuloplasty was a safe and effective adjunct to aortic valve repair. Initial correction of annular dilatation seemed to facilitate overall reconstruction. Because most early repair failures were technical, increasing experience with geometric ring annuloplasty for aortic valve reconstruction has the potential to standardize and improve outcomes.

• Klíčová slova
• Aortic annuloplasty, Aortic insufficiency, Aortic valve repair,
• MeSH
• anuloplastika srdeční chlopně škodlivé účinky   přístrojové vybavení   metody   mortalita   MeSH
• aortální chlopeň chirurgie   MeSH
• aortální insuficience chirurgie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• reoperace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční chlopně umělé škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

Standardization of aortic valve repair techniques with use of a calibrated annuloplasty have led to improved long-term outcomes in dystrophic aortic insufficiency. It can also improve dissemination of techniques and rates of aortic valve repair. Dystrophic aortic insufficiency can be found in three aortic phenotypes: dilated aortic root, dilated ascending aorta and isolated aortic insufficiency. The aortic annulus is invariably dilated above 25 mm in the vast majority of cases of aortic insufficiency, regardless of whether the aorta is dilated or not. A dilated annulus is a risk factor for late failure of aortic valve repair if not addressed at the time of surgery. We perform a calibrated annuloplasty at both sub- and supra-valvular levels in order to restore the ratio of sinotubular junction and annulus. Current evidence shows aortic valve repair reduces valve-related mortality compared to prosthetic valve replacement, with an improved quality of life.

• MeSH
• anuloplastika srdeční chlopně * škodlivé účinky   přístrojové vybavení   mortalita   MeSH
• aortální aneurysma diagnostické zobrazování   mortalita   patofyziologie   chirurgie   MeSH
• aortální chlopeň diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• aortální insuficience diagnostické zobrazování   mortalita   patofyziologie   chirurgie   MeSH
• chirurgická náhrada chlopně * škodlivé účinky   přístrojové vybavení   mortalita   MeSH
• hemodynamika MeSH
• kvalita života MeSH
• lidé MeSH
• obnova funkce MeSH
• rizikové faktory MeSH
• srdeční chlopně umělé MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms. METHODS: Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection. Valve repair was performed using trileaflet (n = 40) or bicuspid (n = 7) internal geometric rings, together with leaflet reconstruction. Ascending aortic and/or remodeling root replacements were accomplished with Dacron grafts 5 to 7 mm larger than the rings. An Echo Core Lab provided independent echocardiographic assessments, and changes over time were evaluated by Friedman tests. RESULTS: Mean ± SD age was 60 ± 14 years, 57% (27/47) were male, 15% (7/47) had bicuspid valves, 87% (41/47) had moderate-to-severe aortic insufficiency, and 13% (6/47) had mild aortic insufficiency. All patients had annular dilatation, with a mean ± SD of 26.5 ± 2.6 mm before repair, and mean ± SD ring sizes were 21.7 ± 1.7 mm. Follow-up was 42 months (mean = 27 months). No operative mortality or valve-related complications occurred. Two patients died beyond 1 year from nonvalve-related causes. One patient required valve replacement for repair failure. Survival free of complications or valve replacement was 94% at 2 years. Significant reduction in aortic insufficiency and New York Heart Association class were observed (P < 0.0001), and valve gradients remained low. No heart block or direct ring complications occurred. CONCLUSIONS: In preliminary regulatory studies, aortic ring annuloplasty seemed safe and effective during aortic aneurysm surgery. This approach could help standardize aortic valve repair.

• MeSH
• anuloplastika srdeční chlopně * škodlivé účinky   přístrojové vybavení   mortalita   statistika a číselné údaje   MeSH
• aortální aneurysma mortalita   chirurgie   MeSH
• aortální chlopeň chirurgie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace MeSH
• protézy - design MeSH
• reoperace MeSH
• senioři MeSH
• srdeční chlopně umělé škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The Ross procedure is an alternative technique to mechanical prosthesis and recent evidence suggests that it is associated with improved long-term survival and quality of life. However, late pulmonary autograft failure can occur more frequently in patients with significant dilation of the aortic annulus. Here, we present a technical modification of the Ross procedure--a case report of a patient who underwent a Ross procedure in which the gross dilation of the aortic annulus was reduced by implantation of an extra-aortic Coronéo annuloplasty ring. Before discharge, we performed a multidetector computed tomography (MDCT) to verify the effect of extra-aortic annuloplasty on the geometry of the neoaortic root and particularly on the dimension of the aortic annulus. The result of the MDCT demonstrated that the ring sits in the optimal position at the level of aortoventricular base and that aortic annulus is significantly reduced.

• MeSH
• anuloplastika srdeční chlopně metody   MeSH
• aorta thoracica MeSH
• aortální insuficience patologie   chirurgie   MeSH
• chirurgická náhrada chlopně metody   MeSH
• dilatace patologická chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní chlopeň patologie   MeSH
• velikost orgánu MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

OBJECTIVES: A geometric annuloplasty ring could improve efficacy and stability of aortic valve repair. Toward this goal, a 1-piece 3-dimensional titanium annuloplasty ring with Dacron covering was developed and tested successfully in animals. The purpose of this study was to define hemodynamic outcomes with this device used as the annuloplasty component of human aortic valve repair. METHODS: In a 4-center pilot trial with informed consent, 16 patients underwent aortic valve repair for aortic insufficiency, with the annuloplasty device sutured into the annulus beneath the leaflets. Preoperative annular diameter averaged 26.5 ± 2.0 (mean ± standard deviation) mm, and average ring size was 22.3 ± 1.2 mm. After annuloplasty, leaflet defects were easy to identify, and 14 of 16 patients (88%) required leaflet plication and/or autologous pericardial reconstruction for leaflet defects. Three patients had ascending aortic replacement, and 2 had remodeling root replacement. One had ultrasonic leaflet decalcification and another tricuspid valve annuloplasty. Follow-up data were from site-specific studies at the 6-month postoperative time point. RESULTS: There were no in-hospital mortalities or major complications. Preoperative aortic insufficiency grade (0-4 scale) was 3.6 ± 1.0 and fell to 1.0 ± 0.8 at 6 months (P < .0001). New York Heart Association class fell from 2.5 ± 0.5 to 1.1 ± 0.3 (P < .0001). Postrepair valve area was 2.7 ± 0.2 cm(2), and 6-month mean systolic gradient was 11.3 ± 3.3 mm Hg. Left ventricular end-diastolic diameter and ejection fraction both normalized (both P < .0001). CONCLUSIONS: Geometric ring annuloplasty facilitated aortic valve repair, allowing more precise reconstruction of leaflet defects. Aortic insufficiency reduction and systolic gradients were excellent, and expansion of valve reconstruction into broader categories of aortic valve disease seems indicated.

• MeSH
• anuloplastika srdeční chlopně přístrojové vybavení   MeSH
• aortální chlopeň diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• aortální insuficience diagnóza   patofyziologie   chirurgie   MeSH
• barevná dopplerovská echokardiografie MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně přístrojové vybavení   MeSH
• echokardiografie transezofageální MeSH
• hemodynamika * MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• pilotní projekty MeSH
• polyethylentereftaláty MeSH
• protézy - design MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční chlopně umělé * MeSH
• stupeň závažnosti nemoci MeSH
• titan MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• polyethylentereftaláty MeSH
• titan MeSH

OBJECTIVE: We investigated long-term outcomes of bicuspid aortic valve (BAV) repair, with external annuloplasty, according to aorta phenotype. METHODS: Between 2003 and 2020, all patients with BAV operated on for aortic insufficiency (AI) and/or aneurysm were included. Repairs included isolated AI repair with subvalvular with or without sinotubular junction (STJ) (single or double) annuloplasty, supracoronary aorta replacement (with or without hemiroot remodeling), and root remodeling with external subvalvular ring annuloplasty. RESULTS: Among 343 patients operated, reparability rate was 81.3% (n = 279; age 46 ± 13.3 years). At 10 years (median follow-up: 3.42 years; interquartile range, 1.1, 5.8), survival was 93.9% (n = 8 deaths, similar to general population), cumulative incidence of reoperation was 6.2% (n = 10), AI grade >2 was 5.8% (n = 9), and grade >1 was 23.0% (n = 30). BAV repair stabilizing both the annulus and STJ with annuloplasty, compared with nonstabilized STJ repair (single annuloplasty), had lower incidence of reoperation (2.6% vs 22.5%, P = .0018) and AI grade >2 (1.2% vs 23.6%, P < .001) at 9 years. Initial commissural angle <160° was not a risk factor for reoperation, compared with angle ≥160° if symmetrical repair was achieved (2.7% and 4.1%, respectively, at 6 years, P = .85). Multivariable model showed that absence of STJ stabilization (odds ratio, 6.7; 95% confidence interval, 2.1-20, P = .001) increased recurrent AI, but not initial commissural angle <160° (odds ratio, 1.01; 95% confidence interval, 0.39-2.63, P = .98). Commissures adjusted symmetrically led to lower transvalvular gradient, compared with nonsymmetrical repair (8.7 mm Hg vs 10.2 mm Hg, P = .029). CONCLUSIONS: BAV repair, tailored to aorta phenotype, is associated with excellent durable outcomes if both annulus and STJ are reduced and stabilized with external ring annuloplasty. Commissural angle <160° is not associated with reoperation if symmetrical repair is achieved.

• Klíčová slova
• annuloplasty, aortic aneurysm, aortic insufficiency, aortic valve repair, bicuspid aortic valve,
• MeSH
• anuloplastika srdeční chlopně * škodlivé účinky   mortalita   metody   MeSH
• aortální aneurysma chirurgie   diagnostické zobrazování   mortalita   MeSH
• aortální chlopeň chirurgie   abnormality   diagnostické zobrazování   patofyziologie   MeSH
• aortální insuficience * chirurgie   patofyziologie   diagnostické zobrazování   mortalita   MeSH
• bikuspidální aortální chlopeň * chirurgie   patofyziologie   MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně škodlivé účinky   přístrojové vybavení   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   MeSH
• reoperace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• anuloplastika srdeční chlopně výchova   MeSH
• aorta thoracica chirurgie   MeSH
• aortální chlopeň abnormality   chirurgie   MeSH
• bikuspidální aortální chlopeň MeSH
• kardiologie výchova   MeSH
• lidé MeSH
• nemoci srdečních chlopní chirurgie   MeSH
• šicí techniky výchova   MeSH
• studium lékařství specializační postgraduální metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• audiovizuální média MeSH
• práce podpořená grantem MeSH
• úvodníky MeSH