Early results after implantation of a new geometric annuloplasty ring for aortic valve repair.
BACKGROUND
Aortic valve repair is associated with fewer long-term valve-related complications as compared with valve replacement, and repair is being performed increasingly. A current problem is the lack of a geometric annuloplasty ring to facilitate reconstruction. This paper describes the first clinical application of such a device designed to permanently restore physiologic annular size and geometry during aortic valve repair.


METHODS
Based on mathematical studies of human cadaver valves, as well as computed tomography angiographic analyses of awake patients with normal valves, a three-dimensional annuloplasty ring has been developed, consisting of low-profile, one-piece titanium construction and Dacron cloth covering. The ring design incorporates 2:3 elliptical base geometry and 10-degree outwardly flaring subcommissural posts.


RESULTS
Appropriately sized rings were implanted in 5 patients with severe aortic insufficiency due to annular dilation and anatomic leaflet defects. The rings restored annular geometry and facilitated leaflet repairs in all patients. Each recovered excellent valve function with minimal residual leak. All patients convalesced uneventfully, were discharged within 7 days after surgery, and continue with stable valve function as long as 6 months after implantation.


CONCLUSIONS
Initial clinical application of a geometric aortic annuloplasty ring was associated with excellent device performance and perhaps better repairs. Further clinical series and patient follow-up should identify potential benefits of the device, including improved applicability and stability of aortic valve repair.
Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany.
Domenico
D
Mazzitelli
Christian
C
Nöbauer
J Scott
JS
Rankin
Catalin C
CC
Badiu
Markus
M
Krane
Philip S
PS
Crooke
William E
WE
Cohn
Anke
A
Opitz
Christian
C
Schreiber
Rüdiger
R
Lange
D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008875:Middle Aged; D008962:Models, Theoretical; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome