Adjunctive Ring Annuloplasty in Valve Sparing Root Replacement
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0030
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Bo Chang Wu (1), Michael Kirsch (1), Nicolas Chanes (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Bo Chang Wu
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University of Colorado Anschutz
University of Colorado Anschutz
Michael Kirsch
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University of Colorado Anschutz
University of Colorado Anschutz
Nicolas Chanes
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective:
Valve sparing root replacement (VSRR) has seen increasing usage at large aortic centers for root pathology, with the benefit of preserving the native valve, and in younger patients avoiding lifelong anticoagulation. A common cause of failure of valve sparing root replacement VSRR is graft slippage resulting in aortic insufficiency. This is often due to insufficient depth of dissection, preventing fixation of the VSRR. While some advocate for additional subannular stitches to prevent slippage, we developed a novel method of concomitant ring annuloplasty and VSRR to prevent graft malposition and present our initial results.
Methods:
Using our institutional aortic database, six patients were identified who underwent VSRR with concomitant ring annuloplasty. We discuss their presentation, operative management, and initial follow-up.
Results:
All patients were male, with 3 patients having trileaflet morphology, and three patients having bicuspid Sievers I RL morphology. All patients had concomitant arch dilation requiring adjunctive hemiarch. Full pre-operative valve, root and aortic characteristics are described in Table 1. For all patients, 6 subannular stitches were used, with 5 patients also having leaflet plication performed at the time of the procedure. A 25mm HAART annuloplasty ring with a 30mm Valsalva graft was used in all cases. Intra-operative course was uncomplicated for all patients, with no or trace aortic insufficiency on TEE intra-operatively after repair. One patient required a return to the operating room after persistent hypoxia and post-operative echo found a new ASD that was not seen on pre-operative or intra-operative echo, after which his symptoms of hypoxia improved. Otherwise, post-operative course was uncomplicated for all patients. At three-month follow-up, all patients had no or trace aortic insufficiency and were otherwise doing well.
Conclusion:
Our novel method of concomitant ring annuloplasty at the time of VSRR demonstrated excellent results at short-term follow-up. Ring annuloplasty prevents slippage of VSRR, providing both internal and external support to the repair. Furthermore, given the failure of VSRR is usually due to aortic insufficiency, an internal rigid prosthesis may facilitate TAVR salvage therapy if necessary.
Valve sparing root replacement (VSRR) has seen increasing usage at large aortic centers for root pathology, with the benefit of preserving the native valve, and in younger patients avoiding lifelong anticoagulation. A common cause of failure of valve sparing root replacement VSRR is graft slippage resulting in aortic insufficiency. This is often due to insufficient depth of dissection, preventing fixation of the VSRR. While some advocate for additional subannular stitches to prevent slippage, we developed a novel method of concomitant ring annuloplasty and VSRR to prevent graft malposition and present our initial results.
Methods:
Using our institutional aortic database, six patients were identified who underwent VSRR with concomitant ring annuloplasty. We discuss their presentation, operative management, and initial follow-up.
Results:
All patients were male, with 3 patients having trileaflet morphology, and three patients having bicuspid Sievers I RL morphology. All patients had concomitant arch dilation requiring adjunctive hemiarch. Full pre-operative valve, root and aortic characteristics are described in Table 1. For all patients, 6 subannular stitches were used, with 5 patients also having leaflet plication performed at the time of the procedure. A 25mm HAART annuloplasty ring with a 30mm Valsalva graft was used in all cases. Intra-operative course was uncomplicated for all patients, with no or trace aortic insufficiency on TEE intra-operatively after repair. One patient required a return to the operating room after persistent hypoxia and post-operative echo found a new ASD that was not seen on pre-operative or intra-operative echo, after which his symptoms of hypoxia improved. Otherwise, post-operative course was uncomplicated for all patients. At three-month follow-up, all patients had no or trace aortic insufficiency and were otherwise doing well.
Conclusion:
Our novel method of concomitant ring annuloplasty at the time of VSRR demonstrated excellent results at short-term follow-up. Ring annuloplasty prevents slippage of VSRR, providing both internal and external support to the repair. Furthermore, given the failure of VSRR is usually due to aortic insufficiency, an internal rigid prosthesis may facilitate TAVR salvage therapy if necessary.
Aortic Symposium:
Aortic Root
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