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Hansjoachim Schafers - One of the best experts on this subject based on the ideXlab platform.

  • aortic root numeric model annulus diameter prediction of Effective Height and coaptation in post aortic valve repair
    The Journal of Thoracic and Cardiovascular Surgery, 2013
    Co-Authors: Gil Marom, Hansjoachim Schafers, Rami Hajali, Moshe Rosenfeld, Ehud Raanani
    Abstract:

    Objective The aim of the present study was to determine the influence of the aortic annulus (AA) diameter in order to examine the performance metrics, such as maximum principal stress, strain energy density, coaptation area, and Effective Height in the aortic valve. Methods Six cases of aortic roots with an AA diameter of 20 and 30 mm were numerically modeled. The coaptation Height and area were calculated from 3-dimensional fluid structure interaction models of the aortic valve and root. The structural model included flexible cusps in a compliant aortic root with material properties similar to the physiologic values. The fluid dynamics model included blood hemodynamics under physiologic diastolic pressures of the left ventricle and ascending aorta. Furthermore, zero flow was assumed for Effective Height calculations, similar to clinical measurements. In these no-flow models, the cusps were loaded with a transvalvular pressure decrease. All other parameters were identical to the fluid structure interaction models. Results The aortic valve models with an AA diameter range of 20 to 26 mm were fully closed, and those with an AA diameter range of 28 to 30 mm were only partially closed. Increasing the AA diameter from 20 to 30 mm decreased the averaged coaptation Height and normalized cusp coaptation area from 3.3 to 0.3 mm and from 27% to 2.8%, respectively. Increasing the AA diameter from 20 to 30 mm decreased the Effective Height from 10.9 to 8.0 mm. Conclusions A decreased AA diameter increased the coaptation Height and area, thereby improving the Effective Height during procedures, which could lead to increased coaptation and better valve performance.

  • preoperative aortic root geometry and postoperative cusp configuration primarily determine long term outcome after valve preserving aortic root repair
    The Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: Takashi Kunihara, Diana Aicher, Svetlana Rodionycheva, Heinrichvolker Groesdonk, Frank Langer, Fumihiro Sata, Hansjoachim Schafers
    Abstract:

    Objective Technical controversies exist in valve-preserving aortic root replacement. We sought to determine predictors of long-term stability of the aortic valve. Methods A total of 430 patients (aged 57 ± 15 years, 323 male) underwent valve-preserving aortic root surgery (remodeling in 401, reimplantation in 29) between 1995 and 2009 and were followed echocardiographically. Factors influencing late recurrence of aortic valve regurgitation grade II or greater (n = 45) or need for reoperation on the aortic valve (n = 25) were analyzed. Results Early mortality was 2.8% (1.9% for elective cases), and actuarial survival at 10 years was 83.5% ± 2.4%. Ten-year freedom from aortic valve regurgitation grade II or greater was 85.0% ± 2.5%. Preoperative aortoventricular junction diameter greater than 28 mm and postoperative Effective Height of the aortic cusp less than 9 mm were identified as significant predictors for late aortic valve regurgitation grade II or greater in multivariate analysis (both P P P  = .022), and Effective Height of the aortic cusp less than 9 mm ( P  = .049) were identified as significant predictors for reoperation in multivariate analysis. Operative technique (remodeling, reimplantation), Marfan syndrome, bicuspid valve anatomy, concomitant central cusp plication, size of prosthesis used, and acute dissection were not associated with an increased risk of late aortic valve regurgitation grade II or greater or reoperation. In patients with preoperative aortoventricular junction diameter greater than 28 mm (n = 94), the addition of central cusp plication significantly improved freedom from aortic valve regurgitation grade II or greater ( P  = .006) regardless of root procedures (remodeling, P  = .011; reimplantation, P  = .053). Conclusions Long-term stability of valve-preserving aortic root replacement was influenced not by the technique of root repair but by the preoperative aortic root geometry and postoperative cusp configuration.

  • valve configuration determines long term results after repair of the bicuspid aortic valve
    Circulation, 2011
    Co-Authors: Diana Aicher, Takashi Kunihara, Omar Abou Issa, Brigitte Brittner, Stefan Graber, Hansjoachim Schafers
    Abstract:

    Background—Reconstruction of the regurgitant bicuspid aortic valve has been performed for >10 years, but there is limited information on long-term results. We analyzed our results to determine the predictors of suboptimal outcome. Methods and Results—Between November 1995 and December 2008, 316 patients (age, 49±14 years; male, 268) underwent reconstruction of a regurgitant bicuspid aortic valve. Intraoperative assessment included extent of fusion, root dimensions, circumferential orientation of the 2 normal commissures (>160°, ≤160°), and Effective Height after repair. Cusp pathology was treated by central plication (n=277), triangular resection (n=138), or pericardial patch (n=94). Root dilatation was treated by subcommissural plication (n=100), root remodeling (n=122), or valve reimplantation (n=2). All patients were followed up echocardiographically (cumulative follow-up, 1253 years; mean, 4±3.1 years). Clinical and morphological parameters were analyzed for correlation with 10-year freedom from reope...

  • aortic root and cusp configuration determine aortic valve function
    European Journal of Cardio-Thoracic Surgery, 2010
    Co-Authors: Benjamin Bierbach, Diana Aicher, Stefan Graber, Omar Abu Issa, Hagen Bomberg, Petra Glombitza, Hansjoachim Schafers
    Abstract:

    Objective: Normalisation of aortic root and cusp configuration is a prerequisite for successful aortic valve repair (AVR). Using transthoracic echocardiography, we studied aortic root dimensions relative to body size in normal subjects and AVR patients. Methods: Aortic roots of healthy volunteers (n = 130, age 27.9 16.9 years) were examined for aortoventricular (AV), sinus (S), sinutubular-junction diameters (ST) and Effective Height (Height difference between the AV plane and central coaptation point, eH) by transthoracic echocardiography. In 651 patients, after AVR residual aortic valve insufficiency (AI) and eH were determined. The relationships between eH versus root dimensions and eH versus residual AI were analysed by analysis of variance with Bonferroni post hoc testing. Results: Root dimensions correlated with each other and body size (r = 0.74—0.91).Inaddition, acorrelationbetweenAV(r = 0.73),sinusdiameter(r = 0.76),bodyHeight(r = 0.77),bodysurfacearea(r = 0.81)and eH was found. After AVR, eH was 9.8 0.9 mm in 235 patients without postoperative AI, 9.4 1.1 mm in 370 with mild AI, 7.9 1.4 mm in 43 patients with moderate AI and 6 1 mm in three patients with severe AI. The difference in means of Effective Height between the groups was significant (p < 0.005). Of 497 AVR patients with an eH 9 mm, 309 had no or trivial AI, 186 had mild AI and only two had moderate AI. Conclusions: Parameters of aortic root dimensions follow a seemingly constant pattern in humans of different sizes. Effective Height has a constant relationship to root dimensions and body size. In AVR, normalisation of eH leads to a high probability of normal or near-normal aortic valve function. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Emmanuel Lansac - One of the best experts on this subject based on the ideXlab platform.

  • remodeling root repair with an external aortic ring annuloplasty
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Ghassan Sleilaty, Stephanie Lejeune, Alain Berrebi, Pavel Zacek, Mathieu Debauchez
    Abstract:

    Abstract Objective 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. Methods 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). Results 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. Conclusions The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp Effective Height assessment improves valve repair outcomes.

  • valve sparing root replacement the remodeling technique with external ring annuloplasty
    Annals of cardiothoracic surgery, 2013
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Jan Vojacek, Jan Nijs, Jaroslav Hlubocky, Gianclaudio Mecozzi, Mathieu Debauchez
    Abstract:

    A standardized approach to aortic valve repair is described associating a physiological remodeling of the root, with resuspension of cusp Effective Height and a subvalvular aortic annuloplasty using an external expansible ring. This device achieves a complete calibrated annuloplasty, in order to increase cups coaptation Height and protect the repair. This is a video-atlas describing the surgical steps of a physiological and standardized approach to aortic valve repair, to treat an aortic root aneurysm associated with grade III to IV eccentric aortic insufficiency on a 41-year old patient with a tricuspid aortic valve (Video 1). Ideal valve sparing root replacement procedure should treat dilatation of the aortic annular base, while preserving dynamics of the aortic root with vortices (neosinuses of Valsalva), root expansibility (interleaflet triangles) as well as restoring cusp coaptation (1-5). Video 1 Valve sparing root replacement: the remodeling technique with external ring annuloplasty The two original valve sparing procedures - remodeling of the aortic root and reimplantation of the aortic valve - focused on root reconstruction to reduce the dilated root diameters in order to restore proper valve function (6,7). The reimplantation technique performs external subvalvular aortic annuloplasty but withdraws the sinuses of Valsalva and includes the interleaflet triangles within a graft tube, thus impairing root dynamics (8-11). In contrast, the remodeling technique provides more physiologic movements of the cusps within three reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles, but without addressing annular base dilation (8-13). In vitro and in vivo studies have documented that cusp motion and flow patterns across the reconstructed aortic root are more physiologic (I) after remodeling of the aortic root than after reimplantation of the aortic valve, and (II) after procedures using a prosthetic conduit fashioned with neo- sinuses of Valsalva than without (9-11). Numerous technical variations have aimed to associate preservation of aortic root dynamics with the treatment of dilated native annulus (14,15). This resulted in a lack of standardization and limited their widespread application. Furthermore, most failures with valve sparing techniques are due to residual cusp prolapse, either as a primary unrecognized lesion or secondary to an induced prolapse after root reconstruction (12,16). Schafers et al. proposed to address this issue with a dedicated caliper in order to restore cusp Effective Height up to 8-10 mm (1,4,12). Therefore we suggest a standardized approach of aortic valve repair addressing both the aorta and the valve, associating a physiological reconstruction of the aortic root according to the remodeling technique, with resuspension of cusp Effective Height and an expansible subvalvular ring annuloplasty (CAVIAAR technique) (Figure 1) (2,17-19). Figure 1 Remodeling of the aortic root associated to an external subvalvular aortic annuloplasty (CAVIAAR technique), combining advantages of the original remodeling and reimplantation techniques To address the need for a dedicated aortic annuloplasty device, we designed a new expansible aortic ring in order to achieve a complete and calibrated annuloplasty in diastole, while maintaining systolic expansibility of the aortic root (Extra-Aortic™, CORONEO, Inc., Montreal, QC, Canada) (19). As such, cusp coaptation Height is increased, reducing stress on the cusps and protecting the repair.

  • an aortic ring from physiologic reconstruction of the root to a standardized approach for aortic valve repair
    The Journal of Thoracic and Cardiovascular Surgery, 2010
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Eric Arnaud Crozat, Olivier Bouchot, Fabien Doguet, Ghassan Sleilaty, Rachid Hacini, Dominique Blin, Jen Paul Bessou, Bernard Albat
    Abstract:

    Objective We suggest standardizing aortic valve repair using a physiologic approach by associating root remodeling with resuspension of the cusp Effective Height and external subvalvular aortic ring annuloplasty. Methods A total of 187 patients underwent remodeling associated with subvalvular aortic ring annuloplasty (14 centers, 24 surgeons). Three strategies for cusp repair were evaluated: group 1, gross visual estimation (74 patients); group 2, alignment of cusp free edges (62 patients); and group 3, 2-step approach, alignment of the cusp free edges and Effective Height resuspension (51 patients). The composite outcome was defined as recurrence of aortic insufficiency of grade 2 or greater and/or reoperation. Results The operative mortality rate was 3.2% (n = 6). Treatment of a cusp lesion was most frequently performed in group 3 (70.6% vs 20.3% in group 1 and 30.6% in group 2, P P Conclusions A standardized and physiologic approach to aortic valve repair, considering both the aorta (root remodeling) and the valve (resuspension of the cusp Effective Height and subvalvular ring annuloplasty) improved the preliminary results and might affect their long-term durability. The ongoing Conservative Aortic Valve Surgery for Aortic Insufficiency and Aneurysm of the Aortic Root (CAVIAAR) trial will compare this strategy to mechanical valve replacement.

  • an aortic ring to standardise aortic valve repair preliminary results of a prospective multicentric cohort of 144 patients
    European Journal of Cardio-Thoracic Surgery, 2010
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Eric Arnaud Crozat, Olivier Bouchot, Ghassan Sleilaty, Dominique Blin, Christophe Acar, Mathieu Debauchez
    Abstract:

    Objectives: Multiplicity of aortic valve repair or sparing techniques results in a lack of standardisation, limiting widespread adoption of such procedures. To treat dilated diameters at the aortic annular base and sinotubular junction while maintaining root dynamics, we propose a standardised and physiological repair approach to the surgical management of aortic root aneurysms, consisting of root remodelling, cusp resuspension and subvalvular aortic ring annuloplasty. Methods: From May 2003 to September 2009, 144 unselected patients with aortic root aneurysms underwent remodelling with external subvalvular ring annuloplasty in 13 centres (21 surgeons). Preoperative aortic insufficiency (AI) grade 2 was present in 63.9% (92), Marfan syndrome in 12.5% (18) and bicuspid valve in 22.9% (33). Cusp repair was performed in 40.3% (58) patients. Results: Valve repair was successful in all but two cases. Repair of cusp prolapse was necessary in 58 patients, significantly more frequent in bicuspid (24/33, 72.7%) than in tricuspid (34/111, 30.6%) valves (p < 0.05). Operative mortality was 2.8% (four). Subvalvular ring implantation produced a significant annular base reduction from 27.6 2.5 mm to 20.5 2.6 mm (p < 0.01) without significant mean transvalvulargradient (7.2 1.7 mmHg).Duringfollow-up(median2.2years(0.75—4.4,maximum6.25years)),fivepatientsdiedwhileeightrequired a re-operation. Six were operated on during our early experience. Strategy for cusp re-suspension evolved over three operative periods, with a significant increase in the rate of cusp repair. From May 2003 to December 2006: eye balling evaluation (15/67 (22.4%)); from January 2007 to August 2008: alignment of cusp free edges (17/38 (44.7%)); and from September 2008 to September 2009: a two-step standardised repair consisting of alignment of cusp free edges and Effective Height re-suspension (26/39 (66.7%) p < 0.05). Freedom from AI grade 2 was 91.3% (115) at the end of follow-up. Conclusions: Implantation of an external aortic ring provides a reproducible technique for aortic valve repair with satisfactory preliminary results. The ongoing CAVIAAR trial (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root) will compare this standardised repair technique using an expansible aortic ring to mechanical valve replacement. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Mathieu Debauchez - One of the best experts on this subject based on the ideXlab platform.

  • remodeling root repair with an external aortic ring annuloplasty
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Ghassan Sleilaty, Stephanie Lejeune, Alain Berrebi, Pavel Zacek, Mathieu Debauchez
    Abstract:

    Abstract Objective 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. Methods 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). Results 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. Conclusions The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp Effective Height assessment improves valve repair outcomes.

  • valve sparing root replacement the remodeling technique with external ring annuloplasty
    Annals of cardiothoracic surgery, 2013
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Jan Vojacek, Jan Nijs, Jaroslav Hlubocky, Gianclaudio Mecozzi, Mathieu Debauchez
    Abstract:

    A standardized approach to aortic valve repair is described associating a physiological remodeling of the root, with resuspension of cusp Effective Height and a subvalvular aortic annuloplasty using an external expansible ring. This device achieves a complete calibrated annuloplasty, in order to increase cups coaptation Height and protect the repair. This is a video-atlas describing the surgical steps of a physiological and standardized approach to aortic valve repair, to treat an aortic root aneurysm associated with grade III to IV eccentric aortic insufficiency on a 41-year old patient with a tricuspid aortic valve (Video 1). Ideal valve sparing root replacement procedure should treat dilatation of the aortic annular base, while preserving dynamics of the aortic root with vortices (neosinuses of Valsalva), root expansibility (interleaflet triangles) as well as restoring cusp coaptation (1-5). Video 1 Valve sparing root replacement: the remodeling technique with external ring annuloplasty The two original valve sparing procedures - remodeling of the aortic root and reimplantation of the aortic valve - focused on root reconstruction to reduce the dilated root diameters in order to restore proper valve function (6,7). The reimplantation technique performs external subvalvular aortic annuloplasty but withdraws the sinuses of Valsalva and includes the interleaflet triangles within a graft tube, thus impairing root dynamics (8-11). In contrast, the remodeling technique provides more physiologic movements of the cusps within three reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles, but without addressing annular base dilation (8-13). In vitro and in vivo studies have documented that cusp motion and flow patterns across the reconstructed aortic root are more physiologic (I) after remodeling of the aortic root than after reimplantation of the aortic valve, and (II) after procedures using a prosthetic conduit fashioned with neo- sinuses of Valsalva than without (9-11). Numerous technical variations have aimed to associate preservation of aortic root dynamics with the treatment of dilated native annulus (14,15). This resulted in a lack of standardization and limited their widespread application. Furthermore, most failures with valve sparing techniques are due to residual cusp prolapse, either as a primary unrecognized lesion or secondary to an induced prolapse after root reconstruction (12,16). Schafers et al. proposed to address this issue with a dedicated caliper in order to restore cusp Effective Height up to 8-10 mm (1,4,12). Therefore we suggest a standardized approach of aortic valve repair addressing both the aorta and the valve, associating a physiological reconstruction of the aortic root according to the remodeling technique, with resuspension of cusp Effective Height and an expansible subvalvular ring annuloplasty (CAVIAAR technique) (Figure 1) (2,17-19). Figure 1 Remodeling of the aortic root associated to an external subvalvular aortic annuloplasty (CAVIAAR technique), combining advantages of the original remodeling and reimplantation techniques To address the need for a dedicated aortic annuloplasty device, we designed a new expansible aortic ring in order to achieve a complete and calibrated annuloplasty in diastole, while maintaining systolic expansibility of the aortic root (Extra-Aortic™, CORONEO, Inc., Montreal, QC, Canada) (19). As such, cusp coaptation Height is increased, reducing stress on the cusps and protecting the repair.

  • an aortic ring to standardise aortic valve repair preliminary results of a prospective multicentric cohort of 144 patients
    European Journal of Cardio-Thoracic Surgery, 2010
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Eric Arnaud Crozat, Olivier Bouchot, Ghassan Sleilaty, Dominique Blin, Christophe Acar, Mathieu Debauchez
    Abstract:

    Objectives: Multiplicity of aortic valve repair or sparing techniques results in a lack of standardisation, limiting widespread adoption of such procedures. To treat dilated diameters at the aortic annular base and sinotubular junction while maintaining root dynamics, we propose a standardised and physiological repair approach to the surgical management of aortic root aneurysms, consisting of root remodelling, cusp resuspension and subvalvular aortic ring annuloplasty. Methods: From May 2003 to September 2009, 144 unselected patients with aortic root aneurysms underwent remodelling with external subvalvular ring annuloplasty in 13 centres (21 surgeons). Preoperative aortic insufficiency (AI) grade 2 was present in 63.9% (92), Marfan syndrome in 12.5% (18) and bicuspid valve in 22.9% (33). Cusp repair was performed in 40.3% (58) patients. Results: Valve repair was successful in all but two cases. Repair of cusp prolapse was necessary in 58 patients, significantly more frequent in bicuspid (24/33, 72.7%) than in tricuspid (34/111, 30.6%) valves (p < 0.05). Operative mortality was 2.8% (four). Subvalvular ring implantation produced a significant annular base reduction from 27.6 2.5 mm to 20.5 2.6 mm (p < 0.01) without significant mean transvalvulargradient (7.2 1.7 mmHg).Duringfollow-up(median2.2years(0.75—4.4,maximum6.25years)),fivepatientsdiedwhileeightrequired a re-operation. Six were operated on during our early experience. Strategy for cusp re-suspension evolved over three operative periods, with a significant increase in the rate of cusp repair. From May 2003 to December 2006: eye balling evaluation (15/67 (22.4%)); from January 2007 to August 2008: alignment of cusp free edges (17/38 (44.7%)); and from September 2008 to September 2009: a two-step standardised repair consisting of alignment of cusp free edges and Effective Height re-suspension (26/39 (66.7%) p < 0.05). Freedom from AI grade 2 was 91.3% (115) at the end of follow-up. Conclusions: Implantation of an external aortic ring provides a reproducible technique for aortic valve repair with satisfactory preliminary results. The ongoing CAVIAAR trial (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root) will compare this standardised repair technique using an expansible aortic ring to mechanical valve replacement. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Isabelle Di Centa - One of the best experts on this subject based on the ideXlab platform.

  • remodeling root repair with an external aortic ring annuloplasty
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Ghassan Sleilaty, Stephanie Lejeune, Alain Berrebi, Pavel Zacek, Mathieu Debauchez
    Abstract:

    Abstract Objective 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. Methods 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). Results 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. Conclusions The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp Effective Height assessment improves valve repair outcomes.

  • an expansible aortic ring to preserve aortic root dynamics after aortic valve repair
    European Journal of Cardio-Thoracic Surgery, 2015
    Co-Authors: Mijiti Wuliya, Isabelle Di Centa, Ghassan Sleilaty, Alain Berrebi, Nizar Khelil, Daniel Czitrom, Leila Mankoubi, Milena Noghin, Marie Christine Malergue, G Chatellier
    Abstract:

    OBJECTIVES: Aortic annuloplasty and preservation of root dynamics have been described as factors for durability of aortic valve repair. The objective of this study is to document the first clinical analysis of root dynamics after a standardized valve-sparing procedure for root aneurysms associating a calibrated expansible external aortic ring annuloplasty with a physiological remodelling of the aortic root (CAVIAAR technique: Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root). METHODS: Of the 600 patients operated on with the CAVIAAR technique, 60 consecutive patients from a single team underwent double independent reading of the echocardiographic analysis performed in the operative period and yearly after discharge until a maximum of 5-year follow-up. Forty-four patients had preoperative aortic insufficiency (AI) ≥grade 2 (73.3%) and 29 patients (48%) had bicuspid valves. RESULTS: The expansible aortic ring (median size 27 (25–27) mm) significantly reduced the aortic annular base diameter (from 28 (25–29) mm to 23 (21–24) mm) (P< 0.001) without a significant median transvalvular gradient increase (P= 0.545). Cusp repair was performed in 55 patients (91.7%). Operative mortality was 1.7% (1). During the median 19-month (95% confidential interval [11–26]) follow-up, annular diameter and cusp Effective Height remained stable. There were no valve-related reoperations. One patient died at 6 months postoperatively from congestive heart failure. Freedom from AI ≥grade 2 was 100% at 1-year follow-up and 96.8% ± 3.2% at 3-year follow-up. Systolic root expansibility of the four echocardiographic diameters (aortic annular base, sinuses of Valsalva level, sino tubular junction and tubular aorta) was maintained, throughout the follow-up period with the aortic annular base expansibility coefficient having consistently higher values than the three other levels. CONCLUSIONS: The expansible aortic ring achieved a complete calibrated external annuloplasty and maintained dynamics of the aortic root at mid-term follow-up. Whether this could be a factor for durability of aortic valve repair is currently under evaluation through the CAVIAAR study 10-year follow-up.

  • valve sparing root replacement the remodeling technique with external ring annuloplasty
    Annals of cardiothoracic surgery, 2013
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Jan Vojacek, Jan Nijs, Jaroslav Hlubocky, Gianclaudio Mecozzi, Mathieu Debauchez
    Abstract:

    A standardized approach to aortic valve repair is described associating a physiological remodeling of the root, with resuspension of cusp Effective Height and a subvalvular aortic annuloplasty using an external expansible ring. This device achieves a complete calibrated annuloplasty, in order to increase cups coaptation Height and protect the repair. This is a video-atlas describing the surgical steps of a physiological and standardized approach to aortic valve repair, to treat an aortic root aneurysm associated with grade III to IV eccentric aortic insufficiency on a 41-year old patient with a tricuspid aortic valve (Video 1). Ideal valve sparing root replacement procedure should treat dilatation of the aortic annular base, while preserving dynamics of the aortic root with vortices (neosinuses of Valsalva), root expansibility (interleaflet triangles) as well as restoring cusp coaptation (1-5). Video 1 Valve sparing root replacement: the remodeling technique with external ring annuloplasty The two original valve sparing procedures - remodeling of the aortic root and reimplantation of the aortic valve - focused on root reconstruction to reduce the dilated root diameters in order to restore proper valve function (6,7). The reimplantation technique performs external subvalvular aortic annuloplasty but withdraws the sinuses of Valsalva and includes the interleaflet triangles within a graft tube, thus impairing root dynamics (8-11). In contrast, the remodeling technique provides more physiologic movements of the cusps within three reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles, but without addressing annular base dilation (8-13). In vitro and in vivo studies have documented that cusp motion and flow patterns across the reconstructed aortic root are more physiologic (I) after remodeling of the aortic root than after reimplantation of the aortic valve, and (II) after procedures using a prosthetic conduit fashioned with neo- sinuses of Valsalva than without (9-11). Numerous technical variations have aimed to associate preservation of aortic root dynamics with the treatment of dilated native annulus (14,15). This resulted in a lack of standardization and limited their widespread application. Furthermore, most failures with valve sparing techniques are due to residual cusp prolapse, either as a primary unrecognized lesion or secondary to an induced prolapse after root reconstruction (12,16). Schafers et al. proposed to address this issue with a dedicated caliper in order to restore cusp Effective Height up to 8-10 mm (1,4,12). Therefore we suggest a standardized approach of aortic valve repair addressing both the aorta and the valve, associating a physiological reconstruction of the aortic root according to the remodeling technique, with resuspension of cusp Effective Height and an expansible subvalvular ring annuloplasty (CAVIAAR technique) (Figure 1) (2,17-19). Figure 1 Remodeling of the aortic root associated to an external subvalvular aortic annuloplasty (CAVIAAR technique), combining advantages of the original remodeling and reimplantation techniques To address the need for a dedicated aortic annuloplasty device, we designed a new expansible aortic ring in order to achieve a complete and calibrated annuloplasty in diastole, while maintaining systolic expansibility of the aortic root (Extra-Aortic™, CORONEO, Inc., Montreal, QC, Canada) (19). As such, cusp coaptation Height is increased, reducing stress on the cusps and protecting the repair.

  • an aortic ring from physiologic reconstruction of the root to a standardized approach for aortic valve repair
    The Journal of Thoracic and Cardiovascular Surgery, 2010
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Eric Arnaud Crozat, Olivier Bouchot, Fabien Doguet, Ghassan Sleilaty, Rachid Hacini, Dominique Blin, Jen Paul Bessou, Bernard Albat
    Abstract:

    Objective We suggest standardizing aortic valve repair using a physiologic approach by associating root remodeling with resuspension of the cusp Effective Height and external subvalvular aortic ring annuloplasty. Methods A total of 187 patients underwent remodeling associated with subvalvular aortic ring annuloplasty (14 centers, 24 surgeons). Three strategies for cusp repair were evaluated: group 1, gross visual estimation (74 patients); group 2, alignment of cusp free edges (62 patients); and group 3, 2-step approach, alignment of the cusp free edges and Effective Height resuspension (51 patients). The composite outcome was defined as recurrence of aortic insufficiency of grade 2 or greater and/or reoperation. Results The operative mortality rate was 3.2% (n = 6). Treatment of a cusp lesion was most frequently performed in group 3 (70.6% vs 20.3% in group 1 and 30.6% in group 2, P P Conclusions A standardized and physiologic approach to aortic valve repair, considering both the aorta (root remodeling) and the valve (resuspension of the cusp Effective Height and subvalvular ring annuloplasty) improved the preliminary results and might affect their long-term durability. The ongoing Conservative Aortic Valve Surgery for Aortic Insufficiency and Aneurysm of the Aortic Root (CAVIAAR) trial will compare this strategy to mechanical valve replacement.

  • an aortic ring to standardise aortic valve repair preliminary results of a prospective multicentric cohort of 144 patients
    European Journal of Cardio-Thoracic Surgery, 2010
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Eric Arnaud Crozat, Olivier Bouchot, Ghassan Sleilaty, Dominique Blin, Christophe Acar, Mathieu Debauchez
    Abstract:

    Objectives: Multiplicity of aortic valve repair or sparing techniques results in a lack of standardisation, limiting widespread adoption of such procedures. To treat dilated diameters at the aortic annular base and sinotubular junction while maintaining root dynamics, we propose a standardised and physiological repair approach to the surgical management of aortic root aneurysms, consisting of root remodelling, cusp resuspension and subvalvular aortic ring annuloplasty. Methods: From May 2003 to September 2009, 144 unselected patients with aortic root aneurysms underwent remodelling with external subvalvular ring annuloplasty in 13 centres (21 surgeons). Preoperative aortic insufficiency (AI) grade 2 was present in 63.9% (92), Marfan syndrome in 12.5% (18) and bicuspid valve in 22.9% (33). Cusp repair was performed in 40.3% (58) patients. Results: Valve repair was successful in all but two cases. Repair of cusp prolapse was necessary in 58 patients, significantly more frequent in bicuspid (24/33, 72.7%) than in tricuspid (34/111, 30.6%) valves (p < 0.05). Operative mortality was 2.8% (four). Subvalvular ring implantation produced a significant annular base reduction from 27.6 2.5 mm to 20.5 2.6 mm (p < 0.01) without significant mean transvalvulargradient (7.2 1.7 mmHg).Duringfollow-up(median2.2years(0.75—4.4,maximum6.25years)),fivepatientsdiedwhileeightrequired a re-operation. Six were operated on during our early experience. Strategy for cusp re-suspension evolved over three operative periods, with a significant increase in the rate of cusp repair. From May 2003 to December 2006: eye balling evaluation (15/67 (22.4%)); from January 2007 to August 2008: alignment of cusp free edges (17/38 (44.7%)); and from September 2008 to September 2009: a two-step standardised repair consisting of alignment of cusp free edges and Effective Height re-suspension (26/39 (66.7%) p < 0.05). Freedom from AI grade 2 was 91.3% (115) at the end of follow-up. Conclusions: Implantation of an external aortic ring provides a reproducible technique for aortic valve repair with satisfactory preliminary results. The ongoing CAVIAAR trial (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root) will compare this standardised repair technique using an expansible aortic ring to mechanical valve replacement. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

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  • remodeling root repair with an external aortic ring annuloplasty
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Ghassan Sleilaty, Stephanie Lejeune, Alain Berrebi, Pavel Zacek, Mathieu Debauchez
    Abstract:

    Abstract Objective 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. Methods 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). Results 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. Conclusions The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp Effective Height assessment improves valve repair outcomes.

  • an expansible aortic ring to preserve aortic root dynamics after aortic valve repair
    European Journal of Cardio-Thoracic Surgery, 2015
    Co-Authors: Mijiti Wuliya, Isabelle Di Centa, Ghassan Sleilaty, Alain Berrebi, Nizar Khelil, Daniel Czitrom, Leila Mankoubi, Milena Noghin, Marie Christine Malergue, G Chatellier
    Abstract:

    OBJECTIVES: Aortic annuloplasty and preservation of root dynamics have been described as factors for durability of aortic valve repair. The objective of this study is to document the first clinical analysis of root dynamics after a standardized valve-sparing procedure for root aneurysms associating a calibrated expansible external aortic ring annuloplasty with a physiological remodelling of the aortic root (CAVIAAR technique: Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root). METHODS: Of the 600 patients operated on with the CAVIAAR technique, 60 consecutive patients from a single team underwent double independent reading of the echocardiographic analysis performed in the operative period and yearly after discharge until a maximum of 5-year follow-up. Forty-four patients had preoperative aortic insufficiency (AI) ≥grade 2 (73.3%) and 29 patients (48%) had bicuspid valves. RESULTS: The expansible aortic ring (median size 27 (25–27) mm) significantly reduced the aortic annular base diameter (from 28 (25–29) mm to 23 (21–24) mm) (P< 0.001) without a significant median transvalvular gradient increase (P= 0.545). Cusp repair was performed in 55 patients (91.7%). Operative mortality was 1.7% (1). During the median 19-month (95% confidential interval [11–26]) follow-up, annular diameter and cusp Effective Height remained stable. There were no valve-related reoperations. One patient died at 6 months postoperatively from congestive heart failure. Freedom from AI ≥grade 2 was 100% at 1-year follow-up and 96.8% ± 3.2% at 3-year follow-up. Systolic root expansibility of the four echocardiographic diameters (aortic annular base, sinuses of Valsalva level, sino tubular junction and tubular aorta) was maintained, throughout the follow-up period with the aortic annular base expansibility coefficient having consistently higher values than the three other levels. CONCLUSIONS: The expansible aortic ring achieved a complete calibrated external annuloplasty and maintained dynamics of the aortic root at mid-term follow-up. Whether this could be a factor for durability of aortic valve repair is currently under evaluation through the CAVIAAR study 10-year follow-up.

  • an aortic ring from physiologic reconstruction of the root to a standardized approach for aortic valve repair
    The Journal of Thoracic and Cardiovascular Surgery, 2010
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Eric Arnaud Crozat, Olivier Bouchot, Fabien Doguet, Ghassan Sleilaty, Rachid Hacini, Dominique Blin, Jen Paul Bessou, Bernard Albat
    Abstract:

    Objective We suggest standardizing aortic valve repair using a physiologic approach by associating root remodeling with resuspension of the cusp Effective Height and external subvalvular aortic ring annuloplasty. Methods A total of 187 patients underwent remodeling associated with subvalvular aortic ring annuloplasty (14 centers, 24 surgeons). Three strategies for cusp repair were evaluated: group 1, gross visual estimation (74 patients); group 2, alignment of cusp free edges (62 patients); and group 3, 2-step approach, alignment of the cusp free edges and Effective Height resuspension (51 patients). The composite outcome was defined as recurrence of aortic insufficiency of grade 2 or greater and/or reoperation. Results The operative mortality rate was 3.2% (n = 6). Treatment of a cusp lesion was most frequently performed in group 3 (70.6% vs 20.3% in group 1 and 30.6% in group 2, P P Conclusions A standardized and physiologic approach to aortic valve repair, considering both the aorta (root remodeling) and the valve (resuspension of the cusp Effective Height and subvalvular ring annuloplasty) improved the preliminary results and might affect their long-term durability. The ongoing Conservative Aortic Valve Surgery for Aortic Insufficiency and Aneurysm of the Aortic Root (CAVIAAR) trial will compare this strategy to mechanical valve replacement.

  • an aortic ring to standardise aortic valve repair preliminary results of a prospective multicentric cohort of 144 patients
    European Journal of Cardio-Thoracic Surgery, 2010
    Co-Authors: Emmanuel Lansac, Isabelle Di Centa, Eric Arnaud Crozat, Olivier Bouchot, Ghassan Sleilaty, Dominique Blin, Christophe Acar, Mathieu Debauchez
    Abstract:

    Objectives: Multiplicity of aortic valve repair or sparing techniques results in a lack of standardisation, limiting widespread adoption of such procedures. To treat dilated diameters at the aortic annular base and sinotubular junction while maintaining root dynamics, we propose a standardised and physiological repair approach to the surgical management of aortic root aneurysms, consisting of root remodelling, cusp resuspension and subvalvular aortic ring annuloplasty. Methods: From May 2003 to September 2009, 144 unselected patients with aortic root aneurysms underwent remodelling with external subvalvular ring annuloplasty in 13 centres (21 surgeons). Preoperative aortic insufficiency (AI) grade 2 was present in 63.9% (92), Marfan syndrome in 12.5% (18) and bicuspid valve in 22.9% (33). Cusp repair was performed in 40.3% (58) patients. Results: Valve repair was successful in all but two cases. Repair of cusp prolapse was necessary in 58 patients, significantly more frequent in bicuspid (24/33, 72.7%) than in tricuspid (34/111, 30.6%) valves (p < 0.05). Operative mortality was 2.8% (four). Subvalvular ring implantation produced a significant annular base reduction from 27.6 2.5 mm to 20.5 2.6 mm (p < 0.01) without significant mean transvalvulargradient (7.2 1.7 mmHg).Duringfollow-up(median2.2years(0.75—4.4,maximum6.25years)),fivepatientsdiedwhileeightrequired a re-operation. Six were operated on during our early experience. Strategy for cusp re-suspension evolved over three operative periods, with a significant increase in the rate of cusp repair. From May 2003 to December 2006: eye balling evaluation (15/67 (22.4%)); from January 2007 to August 2008: alignment of cusp free edges (17/38 (44.7%)); and from September 2008 to September 2009: a two-step standardised repair consisting of alignment of cusp free edges and Effective Height re-suspension (26/39 (66.7%) p < 0.05). Freedom from AI grade 2 was 91.3% (115) at the end of follow-up. Conclusions: Implantation of an external aortic ring provides a reproducible technique for aortic valve repair with satisfactory preliminary results. The ongoing CAVIAAR trial (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root) will compare this standardised repair technique using an expansible aortic ring to mechanical valve replacement. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.