title: Early results of extra-aortic annuloplasty ring implantation on aortic annular dimensions.
abstract: OBJECTIVE
  Dilatation of the aortic annulus is a cause of recurrent aortic regurgitation following the Ross or Yacoub procedures. Use of an extra-aortic annuloplasty ring is a potentially useful adjunct procedure. The aim of this study was to analyze the early effectiveness and mid-term stability of this surgical approach.
  
  
  METHODS
  From 2011 to 2015, 50 patients (mean age, 43 ± 14 years) underwent adjunct extra-aortic annuloplasty ring implantation (n = 39 Dacron rings and n = 11 ExAo rings [CORONEO Inc, Montreal, Canada]). Median ring size was 28 mm (range, 27-32 mm). All patients had aortic regurgitation or a dilated aortic annulus. Concomitant surgical procedure was a valve-sparing remodeling procedure (n = 32) or a Ross procedure (n = 18). Baseline and follow-up echocardiographic systolic and diastolic aortic annular dimensions were prospectively collected. Longitudinal analyses were performed using mixed-effect models. Median follow-up was 12 months (98% complete).
  
  
  RESULTS
  Use of an extra-aortic annuloplasty ring resulted in a significant decrease in both systolic (27.9 ± 0.5 mm preoperatively vs 23.6 ± 0.3 mm at discharge, P < .001) and diastolic (24.8 ± 0.4 mm preoperatively vs 20.3 ± 0.3 mm at discharge, P < .001) dimensions. Mean systolic and diastolic dimensions remained statistically unchanged up to 2 years postoperatively, compared with their predischarge values. Systolic expansion of the annulus was conserved early after surgery (16% systolic expansion) and preserved up to 2 years after ring implantation.
  
  
  CONCLUSIONS
  Use of an extra-aortic annuloplasty ring is effective at reducing annular diameters. This remains stable at mid-term follow-up, with preservation of aortic annular dynamics. Longer-term studies are required to determine the continued stability and impact on long-term clinical outcomes.
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Basmadjian
authors.affiliation: Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada.
authors.forename: Arsène J
authors.initials: AJ
authors.lastname: Basmadjian
authors.affiliation: Division of Cardiac Surgery, CHUM, University of Montreal, Quebec, Canada.
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.affiliation: Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada.
authors.forename: François-Pierre
authors.initials: FP
authors.lastname: Mongeon
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada.
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Poirier
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada. Electronic address: i.elhamamsy@icm-mhi.org.
authors.forename: Ismail
authors.initials: I
authors.lastname: El Hamamsy
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000494:pharmacology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011474:Prosthesis Design / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates
keywords: Ross procedure; annuloplasty; aortic annulus; aortic valve; root remodeling