title: Early results of a novel technique for ring-reinforced aortic valve and root restoration.
abstract: OBJECTIVE
  Surgery for aortic root aneurysm without valve stenosis is increasingly being transformed from the Bentall procedure to valve-sparing aortic root remodelling or reimplantation. In this report, a new repair option is explored, with full functional 'restoration' of the aortic root complex using a geometric annuloplasty ring, leaflet repair, and sinus/ascending aortic replacement with a Valsalva graft.
  
  
  METHODS
  The geometric annuloplasty ring restores elliptical annular shape and size in patients with tri-leaflet aortic insufficiency (AI). The ring mounts the three valve commissures on 10° outwardly flaring posts, and facilitates required leaflet procedures. In clinical application, the device has been effective in achieving stable AI reduction with low valve gradients. In this report, 6 patients with aortic root aneurysms and moderate/severe AI were managed with valve repair using the annuloplasty device and leaflet reconstruction, and then concomitant sinus and ascending aortic graft replacement with coronary implantation.
  
  
  RESULTS
  In the 6 initial root aneurysm patients, there were no in-hospital mortalities, procedural conversions, or valve-related complications. Preoperative AI grade was 2-4 and fell to 0-1 postoperatively. Post-repair mean systolic gradients ranged from 7 to 12 mmHg, and all patients had stable intermediate-term valve function.
  
  
  CONCLUSIONS
  Aortic root restoration using a geometric annuloplasty ring and Valsalva graft may be the most physiological method of aortic valve repair and root replacement. Even with severe leaflet derangements, valve sparing can be achieved with good competence and potentially stable long-term results. This technique could assist in extending valve sparing into most categories of aortic root disease.
  
  
  RESULTS
  Patients were managed as part of a Phase I (ClinicalTrials.gov Identifier: NCT01400841), supported by BioStable Science and Engineering (BSE), Austin, TX, USA; www.biostable-s-e.com.
authors: Department of Cardiovascular Surgery, Technische Universität München, Deutsches Herzzentrum München, Munich, Germany.
authors: Domenico
authors: D
authors: Mazzitelli
authors: Christian
authors: C
authors: Nöbauer
authors: J Scott
authors: JS
authors: Rankin
authors: Catalin C
authors: CC
authors: Badiu
authors: Magdalena
authors: M
authors: Dorfmeister
authors: Philip S
authors: PS
authors: Crooke
authors: Anke
authors: A
authors: Wagner
authors: Christian
authors: C
authors: Schreiber
authors: Rüdiger
authors: R
authors: Lange
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments
keywords: Annuloplasty ring; Aortic aneurysm; Aortic root restoration; Aortic valve; Aortic valve repair; Ring annuloplasty; Valve repair; Valve sparing