Remodeling root repair with an external aortic ring annuloplasty

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Presentation transcript:

Remodeling root repair with an external aortic ring annuloplasty Emmanuel Lansac, MD, PhD, Isabelle Di Centa, MD, Ghassan Sleilaty, MD, Stephanie Lejeune, MS, Alain Berrebi, MD, Pavel Zacek, MD, PhD, Mathieu Debauchez, MD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 5, Pages 1033-1042 (May 2017) DOI: 10.1016/j.jtcvs.2016.12.031 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Standardized steps in remodeling of the aortic root associated with cusp effective height resuspension and external expansible subvalvular aortic ring annuloplasty: A, Five “U” stitches are circumferentially placed, inside out, in the subvalvular plane except at the level of the commissure between the noncoronary and right coronary sinuses where a sixth stitch is placed externally to avoid damage to the membranous septum. Remodeling of the aortic root is then performed by scalloping a bulged graft. B, Measure of cusp effective height with the caliper. C, The anchoring “U” stitches are passed through the inner aspect of the prosthetic aortic ring and tied down externally in the subvalvular position. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan–Meier analysis of freedom from AI grade 2 or greater (A) and AI grade 3 or greater (B) for bicuspid and tricuspid valves. AI, Aortic insufficiency; CI, confidence interval; B, bicuspid; T, tricuspid. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Kaplan–Meier analysis of freedom from aortic valve reoperation (A) and from MAVRE (B) for bicuspid and tricuspid valves. AV, Aortic valve; CI, confidence interval; B, Bicuspid; T, tricuspid; MAVRE, major adverse valve-related events. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Kaplan–Meier analysis of freedom from AI grade 2 or greater (A) and AI grade 3 or greater (B) before 2007 using the Dacron ring and eyeballing repair (Dac, Eh-) and after 2007 with systematic use of calibrated expansible ring annuloplasty, followed 1 year later by systematic cusp effective height assessment (ExAo, Eh+). AI, Aortic insufficiency; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Kaplan–Meier analysis of freedom from aortic valve reoperation (A) and from MAVRE (B) by time period before 2007 using the Dacron ring and eyeballing repair (Dac, Eh-) and after 2007 with systematic use of calibrated expansible ring annuloplasty, followed 1 year later by systematic cusp effective height assessment (ExAo, Eh+). AV, Aortic valve; CI, confidence interval; MAVRE, major adverse valve-related events. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Freedom from reoperation (ExAo + cusp effective height, Dacron ring + eyeballing). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Remodeling root repair with expansible aortic ring annuloplasty for tricuspid valve. Standardized steps in remodeling root repair associated with cusp effective height resuspension and external expansible aortic ring annuloplasty to treat an aortic root aneurysm associated with grade III eccentric AI with tricuspid aortic valves. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)30015-6/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 2 Remodeling root repair with expansible aortic ring annuloplasty for bicuspid valve. Standardized steps in remodeling root repair associated with cusp effective height resuspension and external expansible aortic ring annuloplasty to treat an aortic root aneurysm associated with grade III eccentric AI with bicuspid aortic valves. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)30015-6/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 1033-1042DOI: (10.1016/j.jtcvs.2016.12.031) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions