P030. Adjunctive Ring Annuloplasty in Valve Sparing Root Replacement
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz
Denver, CO
United States - Contact Me
Adam Carroll is a current PGY-3 surgical resident at the University of Colorado. Adam attended medical school at the University of Colorado and has been involved in research with the cardiothoracic surgery department throughout medical school and residency. He has interest specifically in endovascular and transcatheter aortic interventions, as well as neurologic outcomes in aortic research. He is currently in the aortic surgery research labaratory in the Department of Cardiothoracic Surgery at the University of Colorado. He plans to pursue a career in cardiothoracic surgery following his general surgery residency.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
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
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.
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
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.