Meeting abstract

https://doi.org/10.15836/ccar2019.227

Our experience with aortic valve repair with a remodeling technique, extraaortic ring implantation and root replacement

Josip Varvodić ; University Hospital Dubrava, Zagreb, Croatia
Savica Gjorgjievska ; University Hospital Dubrava, Zagreb, Croatia
Davor Barić ; University Hospital Dubrava, Zagreb, Croatia
Daniel Unić ; University Hospital Dubrava, Zagreb, Croatia
Mislav Planinc ; University Hospital Dubrava, Zagreb, Croatia
Marko Kušurin ; University Hospital Dubrava, Zagreb, Croatia
Dubravka Šunjar ; University Hospital Dubrava, Zagreb, Croatia
Sandra Jakšić Jurinjak ; University Hospital Dubrava, Zagreb, Croatia
Ivana Jurin ; University Hospital Dubrava, Zagreb, Croatia
Nikola Bulj ; University Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
Igor Rudež ; University Hospital Dubrava, Zagreb, Croatia

Abstract

Objective: Aortic valve replacement (AVR) is still the most commonly used therapeutic option for patients
suffering from AR. Aortic valve repair (AVRep) is an attractive alternative method, since it avoids
the risks of prosthesis-related complications.1-3 We would like to present our experience with the Yacoub
root remodeling, valve sparing technique with the extraaortic expansible ring.
Patients and Methods: Between November 2014 and July 2019, a total of 79 patients (52.6±13.3 years;
15.2% female, EuroScore II of 3.15%±2) underwent AVRep, 12 due to isolated cusp malcoaptation and 67
associated with aortic root dilatation. Reconstruction was done with the Coroneo Extraaortic Ring (27
(25-31)), and the Gelweave graft (28 (26-32)). 44 patients had a tricuspid valve, 33 patients had a bicuspid
valve, and 2 patients had an unicuspid valve. Concomitant procedures included Mvrep and TVrep in 4
patients, CABG in two patents. Aortic arch was replaced in two patients, two patients underwent hemiarch
replacement, and two patients had aortic arch replacement with stented conduit and placement
of stent in descending thoracic aorta (EVITA stent graft Jotec GmbH). Echocardiography was used to
determine AR severity grade preoperatively, during immediate post-operative period (within 7 days
from operation) and at early follow-up.
Results: In postoperative follow-up no patients died. Freedom from reoperation was 88% (10/79) and
there were 2 patients reoperated due to early postoperative regurgitation, one patient was reoperated
due to AI after two years, and one was operated due to pseudoaneurysm formation after 2.5 years. A
significant decrease in LV end-diastolic diameter was observed (LVEDD) (60mm preoperatively, 53 mm
postoperatively) with further decrease at early follow-up. At follow up none of the patients had major
AR (AR0=61, AR1+=14, AR2+=4).
Conclusions: We have proved that AVRep is a good alternative for patients with aortic insufficiency
and leads to LV reverse remodeling with comparable results in terms of LVEDD and LVEF immediately
post-operatively and at early follow up. It is feasible to use this technique in tricuspid, bicuspid, as well
as unicuspid valves with excellent results.

Keywords

aortic valve reconstruction; aortic root replacement; annuloplasty

Hrčak ID:

226696

URI

https://hrcak.srce.hr/226696

Publication date:

15.10.2019.

Visits: 670 *