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Ahmad Zeeshan, MD, Jay J. Idrees, MD, Douglas R

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1 Durability of Aortic Valve Cusp Repair With and Without Annular Support 
Ahmad Zeeshan, MD, Jay J. Idrees, MD, Douglas R. Johnston, MD, Jeevanantham Rajeswaran, PhD, Eric E. Roselli, MD, Edward G. Soltesz, MD, MPH, A. Marc Gillinov, MD, Brian Griffin, MD, Richard Grimm, DO, Donald F. Hammer, MD, Gösta B. Pettersson, MD, PhD, Eugene H. Blackstone, MD, Joseph F. Sabik, MD, Lars G. Svensson, MD, PhD  The Annals of Thoracic Surgery  Volume 105, Issue 3, Pages (March 2018) DOI: /j.athoracsur Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Newer techniques for aortic valve repair. (A) Aortic valve repair with figure-of-8 (Svensson) suspension sutures. The technique involves placing figure-of-8 suspensory sutures at the leading edge of the cusps. We use 5-0 polytetrafluoroethylene suture placed 3 to 4 mm above the commissure, which is then clipped to prevent unraveling. The technique is also used for tricuspid valves in conjunction with sinutubular-segment tailoring, but only selectively in the case of minor (<2 mm) commissural fenestrations. (B) Cabrol commissuroplasty showing plication (center) and 2 commissural stitches (pledgeted and commissural approximation). If a figure-of-8 (Svensson) stitch is used for the commissural approximation, it is placed through the aortic wall about 3 to 4 mm higher, as in panel A, to support the commissure at a higher level than in the Cabrol commissuroplasty. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Time course of aortic regurgitation (AR) grade after repair. The solid lines show the temporal trends of prevalence of postoperative AR grades. The symbols represent data grouped within time frames, without regard for repeated assessment, simply to provide a crude verification of model fit. (A) Percentage in each grade. (B) Percentage with severe AR with and without a root procedure. The dashed lines represent 68% confidence bands. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Time course of mean aortic valve (AV) gradient after repair. (A) Overall and (B) with and without a root procedure. The solid lines show the temporal trends of mean AV gradient, the symbols represent data grouped within time frames, without regard for repeated assessment, simply to provide a crude verification of model fit, and the dashed lines represent 68% confidence bands. (Preop = preoperative.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Time course of left ventricular (LV) mass index after repair. (A) Overall and (B) with and without a root procedure. The solid lines show the temporal trends of prevalence, the symbols represent data grouped within time frames, without regard for repeated assessment, simply to provide a crude verification of model fit, and the dashed lines represent 68% confidence bands. (Preop = preoperative.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Freedom from reoperation after aortic valve (AV) repair. The solid line represents the parametric estimate enclosed within a 68% confidence band, the symbols depict nonparametric Kaplan-Meier estimates, and the vertical bars indicate 68% confidence intervals. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 Outcomes in patients with bicuspid vs tricuspid aortic valves. (A) Freedom from reoperation after bicuspid vs tricuspid aortic valve (AV) repair. The symbols depict nonparametric Kaplan-Meier estimates, and the vertical bars indicate 68% confidence limits. (B) Change in postoperative gradient over time after bicuspid vs tricuspid AV repair. The solid lines show the temporal trends of mean AV gradient, the symbols represent data grouped within time frames, without regard for repeated assessment, simply to provide a crude verification of model fit, and the dashed lines represent 68% confidence bands. (Preop = preoperative.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Freedom from aortic valve (AV) reoperation according to repair technique: (A) figure-of-8 suspension suture used vs all other techniques, (B) repairs with and without root procedure, (C) repairs with and without commissuroplasty, and (D) repairs stratified by number of cusp procedures used (commissuroplasty, debridement, patching, free-margin plication, cusp suture, cusp resection). The symbols depict nonparametric Kaplan-Meier estimates, and the vertical bars indicate 68% confidence limits. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

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