Advertisement

External suture annuloplasty for mild to moderate and moderate aortic regurgitation due to an isolated type Ic lesion

  • Minoru MatsuhamaEmail author
  • Satoshi Arimura
  • Kenichi Sasaki
  • Hiroaki Semba
  • Yuko Kato
  • Shinya Suzuki
  • Tokuhisa Uejima
  • Junji Yajima
  • Takeshi Yamashita
  • Takashi Kunihara
Original Article
  • 29 Downloads

Abstract

Objective

Whether mild to moderate and moderate aortic regurgitation should be corrected surgically during other cardiovascular surgeries remains controversial. We evaluated the effectiveness of external suture annuloplasty in such cases.

Methods

Among 95 patients undergoing aortic valve repair between December 2013 and March 2018, five patients with mild to moderate and moderate aortic regurgitation due to aortic annulus dilatation (type Ic lesion) underwent surgery for mitral regurgitation and/or thoracic aortic aneurysm. Aortic valves were repaired with external suture annuloplasty alone with a mean Hegar dilator size of 20.4 ± 0.8 (20.0–22.0) mm at the same time and were followed up echocardiographically.

Results

There were no cases of mortality or major morbidity. Intraoperative direct measurement revealed ventriculoaortic junction size of 25.0 ± 0.8 (24.0–27.0) mm. The average cardiopulmonary bypass time and aortic cross-clamping time were 139 ± 46 (76–205) min and 105 ± 38 (58–172) min, respectively. Postoperative transthoracic echocardiogram during hospitalization showed trivial aortic regurgitation in all cases, with average ventriculoaortic junction size, aortic valve area, and peak and mean transvalvular gradient of 19.1 ± 0.7 (18.0–20.3) mm, 2.24 ± 0.48 (1.60–3.00) cm2, 6.4 ± 1.9 (4.0–9.2) mmHg, and 3.5 ± 1.1 (2.1–5.2) mmHg, respectively. Ventriculoaortic junction size was significantly decreased (P < 0.05). There have been no changes in ventriculoaortic junction size (P = 0.32) or other echocardiographic findings for 24 ± 6 (17–36) months after surgery.

Conclusions

Although concomitant with other cardiac surgeries, mild to moderate and moderate aortic regurgitation could be repaired without clinically relevant additional surgical duration. External suture annuloplasty is a useful, safe, and secure treatment choice for type Ic lesion-induced aortic regurgitation.

Keywords

Aortic regurgitation Complex surgery External suture annuloplasty Aortic valvuloplasty Ventriculoaortic junction size 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that no conflicts of interest exist.

References

  1. 1.
    Meester C, Pasquet A, Gerber BL, Vancraeynest D, Noirhomme P, Khoury GE, et al. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: a propensity score analysis. J Thorac Cardiovasc Surg. 2014;148:1913–20.CrossRefGoogle Scholar
  2. 2.
    Vohra HA, Whistance RN, Hechadi J, de Kerchove L, Fuller H, Noirhomme P, et al. Long-term outcomes of concomitant aortic and mitral valve repair. J Thorac Cardiovasc Surg. 2014;148:454–60.CrossRefGoogle Scholar
  3. 3.
    Malas T, Saczkowski R, Sohmer B, Ruel M, Mesana T, de Kerchove L, et al. Is aortic valve repair reproducible? Analysis of the learning curve for aortic valve repair. Can J Cardiol. 2015;31:1497.e15–22.CrossRefGoogle Scholar
  4. 4.
    Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Okamura M, Doki Y, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2014: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2016;64:665–97.CrossRefGoogle Scholar
  5. 5.
    Boodhwani M, de Kerchove L, Glinuer D, Poncelet A, Rubay J, Astarci P, et al. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg. 2009;137:286–94.CrossRefGoogle Scholar
  6. 6.
    Glacer N, Jacson V, Holzmann MJ, Franco-Cereceda A, Sartipy U. Prosthetic valve endocarditis after surgical aortic valve replacement. Circulation. 2017;136:329–31.CrossRefGoogle Scholar
  7. 7.
    Grubitzsch H, Schaefer A, Melzer C, Wernecke KD, Gabbieri D, Konertz W. Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment. J Thorac Cardiovasc Surg. 2014;148:2052–9.CrossRefGoogle Scholar
  8. 8.
    Kunihara T. Annular management during aortic valve repair: a systematic review. Gen Thorac Cardiovasc Surg. 2016;64:63–71.CrossRefGoogle Scholar
  9. 9.
    Rankin JS, He X, O’Brien SM, Jacobs JP, Welke KF, Filardo G, et al. The Society of Thoracic Surgeons risk model for operative mortality after multiple valve surgery. Ann Thorac Surg. 2013;95:1484–90.CrossRefGoogle Scholar
  10. 10.
    Shuhaiber J, Isaacs AJ, Sedrakyan A. The effect of center volume on in-hospital mortality after aortic and mitral valve surgical procedures: a population-based study. Ann Thorac Surg. 2015;100:1340–6.CrossRefGoogle Scholar
  11. 11.
    Rankin JS, Hammill BG, Ferguson TB Jr, Glower DD, O’Brien SM, DeLong ER, et al. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg. 2006;131:547–57.CrossRefGoogle Scholar
  12. 12.
    Vassileva CM, Li S, Thourani VH, Suri RM, Williams ML, Lee R, et al. Outcome characteristics of multiple valve surgery: comparison to single valves. Innovations. 2014;9:27–32.CrossRefGoogle Scholar
  13. 13.
    Lee R, Li S, Rankin JS, O’Brien SM, Gmmie JS, Perterson ED, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011;91:677–84.CrossRefGoogle Scholar
  14. 14.
    Khelil N, Sleilaty G, Palladino M, Fouda M, Escande R, Debauchez M, et al. Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg. 2015;99:1220–6.CrossRefGoogle Scholar
  15. 15.
    Schäfers HJ, Raddatz A, Schmied W, Psych D, Takahashi H, Miura Y, et al. Reexaming remodeling. J Thorac Cardiovasc Surg. 2015;149:S30–6.CrossRefGoogle Scholar
  16. 16.
    Kunihara T. Toward standardization of valve-sparing root replacement and annuloplasty. Gen Thorac Cardiovasc Surg. 2018;66:685–91.CrossRefGoogle Scholar
  17. 17.
    Ouzonian M, Rao V, Manlhiot C, Abraham N, David C, Feindel CM, et al. Valve-sparing root replacement compared with composite valve graft procedures in patients with aortic root dilation. J Am Coll Cardiol. 2016;68:1838–47.CrossRefGoogle Scholar
  18. 18.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.CrossRefGoogle Scholar
  19. 19.
    Miyahara S, Omura A, Sakamoto T, Nomura Y, Inoue T, Minami H, et al. Impact of postoperative cusp configuration on midterm durability after aortic root implantation. J Heart Valve Dis. 2013;22:509–16.Google Scholar
  20. 20.
    Schäfers HJ, Schmied W, Psych D, Marom G, Aicher D. Cusp height in aortic valves. J Thorac Cardiovasc Surg. 2013;146:269–74.CrossRefGoogle Scholar
  21. 21.
    Capps SB, Elikins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg. 2000;119:975–82.CrossRefGoogle Scholar
  22. 22.
    Kunihara T, Arimura S, Sata F, Giebels C, Schneider U, Schäfers HJ, et al. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg. 2018;155:885–94.CrossRefGoogle Scholar
  23. 23.
    Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg. 2017;103:504–10.CrossRefGoogle Scholar
  24. 24.
    Hwang HY, Kim KH, Ahn H. Attitude after a mild aortic valve lesion during rheumatic mitral valve surgery. J Thorac Cardiovasc Surg. 2014;147:1540–6.CrossRefGoogle Scholar
  25. 25.
    Vaturi M, Porter A, Adler Y, Shapira Y, Sahar G, Vidne B, et al. The natural history of aortic valve disease after mitral valve surgery. J Am Coll Cardiol. 1999;33:2003–8.CrossRefGoogle Scholar
  26. 26.
    Choudhary SK, Talwar S, Juneja R, Kumar AS. Fate of mild aortic valve disease after mitral valve intervention. J Thorac Cardiovasc Surg. 2001;122:583–6.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Minoru Matsuhama
    • 1
    Email author
  • Satoshi Arimura
    • 1
  • Kenichi Sasaki
    • 2
  • Hiroaki Semba
    • 3
  • Yuko Kato
    • 3
  • Shinya Suzuki
    • 3
  • Tokuhisa Uejima
    • 3
  • Junji Yajima
    • 3
  • Takeshi Yamashita
    • 3
  • Takashi Kunihara
    • 4
  1. 1.Department of Cardiovascular SurgeryThe Cardiovascular InstituteTokyoJapan
  2. 2.Department of Cardiovascular SurgerySaitama Sekishinkai HospitalSaitamaJapan
  3. 3.Department of CardiologyThe Cardiovascular InstituteTokyoJapan
  4. 4.Department of Cardiac SurgeryThe Jikei University School of MedicineTokyoJapan

Personalised recommendations