New Technique for Aortic Valve Functional Annulus Reshaping Using a Handmade Prosthetic Ring

Background. Despite a wide development in aortic leaflets repair techniques, aortic valve annuloplastic procedures are still poorly investigated. We present our aortic valve annuloplastic system consisting of a handmade prosthetic ring with 2 components for reshaping the aortic annulus and sinotubular junction (STJ) and illustrates our surgical approach and clinical results. Methods. Since February 2003, 45 patients with aortic valve regurgitation underwent aortic annuloplasty using the new ring. Mean patient age was 58 +/- 16 years (range, 46 to 76 years). The ring has 2 components: a circular ring used to undersize the circumference of the aortoventricular junction and 3-crown-like shape ring used for STJ remodeling. The circular ring was sutured into the left ventricular outflow tract in the aortic subvalvular position and the STJ ring was sutured from the outside of the aortic root just at the level of the STJ. The 3 vertical bands of the STJ ring were fixed to the underlying circular ring to stabilize the continuity between the STJ and nadir of the aortic valve. Results. No in-hospital death occurred. Two patients had residual trivial aortic valve regurgitation postoperatively, and 3 patients required treatment for residual aortic regurgitation (more than mild). Mean length of the coaptation surface was 10 +/- 2 mm. The mean clinical follow-up (100% complete) was 22 +/- 16 months. All patients were free from cardiac and valve-related events, and no complications due to ring implantation occurred. Conclusions. This ring reshapes the functional aortic annulus and stabilizes all components of the native aortic valve stent to improve long-term results of valve repair. (Ann Thorac Surg 2011; 91:1154-8) (C) 2011 by The Society of Thoracic Surgeons