Aortic Valve Repair - Alternative to Replacement
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1 Aortic Valve Repair - Alternative to Replacement Seite 1 Dept. of Thoracic and Cardiovascular Surgery University Hospital of Saarland Homburg/ Saar Germany
2 Seite 2
3 Aortic Valve - Historic Repair Attempts Seite 3
4 Aortic Valve Replacement Aortic Repair Introduction Thromboembolism Anticoagulation/Hemorrhage Structural failure PV endocarditis Incidence of valverelated complications Seite 4 Hammermeister et al, JACC 2000
5 AVR - Mechanical Aortic Repair Introduction Prosthesis-related Complications years after valve replacement Seite 5 Ikonomidis JS, JTCVS 2003
6 Repair vs. Replacement (Mitral) Seite Mohty D, Curr. Card. 2002
7 Root Repair Technical Options Subcommissural Plication ST Junction Remodelling Root Remodeling Reimplantation of Aortic Valve (Cabrol 1966) (STJ < 33mm AVJ > 25mm) Seite 7 (Frater 1986) (Sinus < 45 mm, STJ 32 (39) mm (Yacoub 1993) (Sinus > 45 mm (TEE), AVJ < 30 mm) (David 1992) (AVJ 30 mm)
8 Aortic Valve Repair Seite 8
9 Aortic Valve Repair Seite 9
10 Aortic Valve Repair Seite 10
11 Seite 11
12 Reimplantation Remodeling 2 l/min Seite 12
13 Seite 13
14 Seite 14
![[3/2 (a+b) - a b] b r aorta](/docs-images/89/98882627/images/15-2.jpg "a r cusp r cusp 1 / r aorta")
15 Reduction of STJ and Cusp Prolapse b a a b C E = π [3/2 (a+b) - a b] b r aorta a r cusp r cusp 1 / r aorta Seite 15
16 Aortic Valve Repair - Difficulties Dimensions- of aortic root/(ring) Seite 16
17 R NC L Courtesy of E. Lansac Seite
18 Aortic Valve Repair - Difficulties Configuration/coaptation of cusps Vision from outflow Seite 18
19 Aortic Valve Repair - Difficulties Geometry altered by non-pressurized state Seite 19
20 Solutions Geometry altered by non-pressurized state! Stay sutures! Seite 20
21 Aortic Valve Repair - Assessment Difficulties Dimensions- of aortic root/(ring) Configuration/coaptation of cusps Vision from outflow Seite 21 Geometry altered by non-filled state!
22 Aortic Valve Repair - Assessment Solutions Configuration/coaptation of cusps? Swanson, Circ Res 1974 Seite 23
23 Cusp Configuration effective height 1cm Seite 24 Schäfers HJ et al, JTCVS 2006
24 Effective Height effective height 1cm Seite 25
25 Anatomical Limitations of Aortic Valve Repair Aortic Repair Introduction Restrictive pathology Seite 26
26 Aortic Valve Repair - Assessment Solutions Configuration/coaptation of cusps Seite 27
27 Aortic Valve Repair - Assessment Configuration/coaptation of cusps TAV: mm BAV: mm Seite 28
28 Causes of Cusp Pathology Aortic Repair Introduction Prolapse n=606/826 =73% (right > non > left-coronary cusp) Congenital malformation bicuspid n=276 unicuspid n =50 quadricuspid n =3 Congenital Retraction / Calcium n=42 Retraction Prolapse Seite 29
29 Aortic valve stress distribution Seite 30
30 Reconstructive Techniques Prolapse Cusp Pathology Plication of Cusp Margin Seite 31
31 Aortic Valve Repair Freedom from Valve-related Complications 86% Incidence of valverelated complications Seite 32 Hammermeister et al, JACC 2000
32 Seite 33
33 Seite 34
34 Seite 35
35 Root Repair Technical Options Subcommissural Plication? Aortic Annuloplasty (AVJ > 25-27mm) (Cabrol 1966) Seite 36
36 Correction of AV dilatation: Seite 37
37 Seite 38
38 Freedom from Reoperation all BAV Predictors of Failure p univar. p multivar. Seite Patient age < 40 yrs Orientation of comm. (<160 ) Non-root replacement Cabrol suture 0.04 Pericardial patch AV diameter (>28 mm) ST diameter ( 30 mm) Effective height < 9mm Preop AR > III
39 Aortic Valve Reconstruction AV reconstruction is on ist way to a rational and reproducible approach (A + B + C +? = functioning AV) Scientific basis is becoming clearer Valve-related complications are rare if repair is stable AV reconstruction should be considered in every patient with AR Seite 40
40 Thank you for your attention Seite 42
41 Root Repair Technical Options Subcommissural Plication? Aortoventricular Plication (AVJ > 27mm) (Cabrol 1966) Seite 51
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