title: Remodeling root repair with an external aortic ring annuloplasty.
abstract: Although the remodeling technique provides the most dynamic valve-sparing root replacement, a dilated annulus (>25 mm) is a risk factor for failure. Aortic annuloplasty aims to reduce the annulus diameter, thus increasing coaptation height to protect the repair. The results of 177 patients with remodeling and external aortic ring annuloplasty were studied.
  
  
  
  Data were collected from the Aortic Valve repair InternATiOnal Registry. Preoperative aortic insufficiency grade 3 or greater was present in 79 patients (44.7%). The valve was bicuspid in 59 patients (33.3%). External annuloplasty was performed through a homemade Dacron ring (56) or a dedicated expansible aortic ring (121).
  
  
  
  Thirty-day mortality was 2.9% (5). Mean follow-up was 41.1 ± 36.4 months. For the whole series, freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, aortic insufficiency grade 2 or greater, and major adverse valve-related events were 89.5%, 90.5%, 77.4%, and 86.6% at 7 years, respectively, with similar results for tricuspid and bicuspid valves. Since 2007, systematic use of calibrated expansible ring annuloplasty, followed 1 year later by systematic cusp effective height assessment, significantly increased 7-year freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, and major adverse valve-related events up to 99.1% ± 0.9% (P = .017), 100% (P = .026), and 96.3% ± 1.8% (P = .035), respectively, whereas freedom from aortic insufficiency grade 2 or greater remained unaffected (78.1% ± 7.6%). Calibrated annuloplasty and effective height assessment were identified as protective factors from reoperation: hazard ratio, 0.13; 95% confidence interval, 0.02-1.06; P = .057 and hazard ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .044, respectively.
  
  
  
  The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp effective height assessment improves valve repair outcomes.
authors.affiliation: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France. Electronic address: emmanuel.lansac@imm.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lansac
authors.affiliation: Vascular Surgery Unit, Hopital Foch, Suresnes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Di Centa
authors.affiliation: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Ghassan
authors.initials: G
authors.lastname: Sleilaty
authors.affiliation: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lejeune
authors.affiliation: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Berrebi
authors.affiliation: Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital, Hradec Kralove, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Zacek
authors.affiliation: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Debauchez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D018618:Echocardiography, Doppler, Color; D005260:Female; D005602:France; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000209:etiology; D000077982:Progression-Free Survival; D011474:Prosthesis Design; D020127:Recovery of Function; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D011093:Polyethylene Terephthalates
keywords: aortic annuloplasty; aortic ring; effective height; remodeling; valve repair; valve sparing