Simplified Reimplantation: a Bailout in Fragile Aortic Wall Remnants

P0307 

Case Video Submission 

Giulio Folino (1), Andrea Salica (1), Mario Torre (2), Raffaele Scaffa (1), Francesco Giosuè Irace (3), Paolo Ciancarella (4), Ilaria Chirichilli (3), Luca Paolo Weltert (1), Ruggero De Paulis (5)

(1) Department of Cardiac Surgery, European Hospital, Rome, Italy, Rome, IT, (2) University of Naples Federico II, Naples, IT, (3) Department of Cardiac Surgery, Ospedale San Camillo-Forlanini, Rome, Italy, Rome, IT, (4) European Hospital, Rome, IT, (5) European Hospital, Unicamillus University, Rome, IT

Giulio Folino    -  Contact Me
Department of Cardiac Surgery, European Hospital, Rome, Italy

Andrea Salica    -  Contact Me
Department of Cardiac Surgery, European Hospital, Rome, Italy

Mario Torre    -  Contact Me
University of Naples Federico II

Raffaele Scaffa    -  Contact Me
Department of Cardiac Surgery, European Hospital, Rome, Italy

Francesco Giosuè Irace    -  Contact Me
Department of Cardiac Surgery, Ospedale San Camillo-Forlanini, Rome, Italy

Paolo Ciancarella    -  Contact Me
European Hospital

Ilaria Chirichilli    -  Contact Me
Department of Cardiac Surgery, Ospedale San Camillo-Forlanini, Rome, Italy

Luca Paolo Weltert    -  Contact Me
Department of Cardiac Surgery, European Hospital, Rome, Italy

*Ruggero De Paulis    -  Contact Me
European Hospital, Unicamillus University

Giulio Folino    -  Contact Me
Department of Cardiac Surgery, European Hospital, Rome, Italy

Objective: to describe the simplified reimplantation technique, to discuss its range of application and report the early echocardiographic and computed tomography angiography (CTA) results of the technique.
Case Video Summary: 13 patients underwent the simplified reimplantation procedure between December 2022 and November 2023, 2 bicuspid and 11 tricuspid aortic valve patients. The technique was applied to cases of extremely diseased root wall where the aortic remnants were judged fragile and unsuitable for suturing to the Dacron.
The simplified reimplantation was performed as follows: the aortic wall remnants are completely removed. Twelve-pledgeted sutures are placed along the circumference of the virtual basal ring and then passed at the established level of the Valsalva graft (hemostatic suture). The commissures are fixed at the new sinotubular junction with a horizontal pledgeted suture. One pledgeted suture is added vertically within each interleaflet triangle to anchor the aortic valve to the graft. The rest of the procedure is carried out in the standard fashion.
Early echocardiographic results showed none or trivial AR in all patients, no significant gradient. Early postoperative CTA images showed a re-established morphology of the root with a preserved separation of the sinuses of Valsalva. The stabilization of the interleaflet triangles allows a better distribution of the hemodynamic stress along the whole commissure (not only on the tip of the commissure) and avoids blood flow between the commissure and the Dacron.
Conclusions: the simplified reimplantation technique is an excellent bailout strategy for valve sparing in patients with fragile and damaged aortic wall remnants. The early echocardiographic results are excellent. The CTA images show a re-established physiological root morphology and comparable to the standard technique. Longer follow up is needed to evaluate long term results.

Aortic Root