aortic valve repair - static.livemedia.gr · valve repair = ring annuloplasty + leaflet...
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Aortic valve repair
G T Stavridis MD FETCS
Conflicts of interest: none
DISCLOSURES
2/12/201
8 | 5
Prof. Alain Carpentier – AATS Meeting 1983
BioStable Science & Engineering - Confidential
Valve Repair = Ring Annuloplasty + Leaflet Reconstruction
Duran and Al Halees
History of Aortic Valve Repair
Reimplantation (Tyrone David) Remodeling (Yacoub)
History of Aortic Valve Repair
History of Aortic Valve Repair
Hans-Joachim Schaefers Gebrine El Khoury
History of Aortic Valve Repair
Internal Suture AnnuloplastyHistory of Aortic Valve Repair
External Ring Annuloplasty
History of Aortic Valve Repair
External Suture Annuloplasty (Schaefers)
and Subcommissural Suture Annuloplasty (Cabrol)
History of Aortic Valve Repair
Internal Ring Annuloplasty
Ann Thorac Surg. 2013 Jan;95(1):94-7
Aortic Valve Repair
8/30/16 | 1
Prof. Alain Carpentier – AATS Meeting 1983
BioStable Science & Engineering - Confidential
Valve Repair = Ring Annuloplasty + Leaflet Reconstruction
8/30/16 | 11
New Model Of Aortic Valve & Root Anatomy
BioStable Science & Engineering - Confidential
Clarifies relationship between leaflet and annular anatomy required for coaptation
Rankin JS, et al. A refined hemispherical model of normal human aortic valve and root geometry. J Thoracic Cardiovasc Surg. 2013 Jul;146(1):103-108.
High-Resolution CT Angiography11 Patients undergoing Coronary Screening
With Normal Aortic Valves
Aortic Valve Repair
8/30/16 | 30
1. HAART geometric ring annuloplasty
2. Appropriate leaflet reconstruction
3. Aneurism resected with coronary buttons
4. Root remodeling using aortic root graft
5. Coronary implantation and distal anastomosis
Aortic Valve & Root Restoration
BioStable Science & Engineering - Confidential
High-Resolution CT Angiography
The Normal Aortic Root is not Expansile
Suggesting the Utility of a Rigid Titanium Ring
Aortic Valve Repair
Hemispherical Aortic Annuloplasty Reconstructive Technology
Aortic Valve Repair
8/30/16 | 1
Prof. Alain Carpentier – AATS Meeting 1983
BioStable Science & Engineering - Confidential
Valve Repair = Ring Annuloplasty + Leaflet Reconstruction
8/30/16 | 11
New Model Of Aortic Valve & Root Anatomy
BioStable Science & Engineering - Confidential
Clarifies relationship between leaflet and annular anatomy required for coaptation
Rankin JS, et al. A refined hemispherical model of normal human aortic valve and root geometry. J Thoracic Cardiovasc Surg. 2013 Jul;146(1):103-108.
Aortic Valve Repair
Valve
Repair
Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults Ismail Bouhout, et al JTCVS 2014 Volume 148, Issue 4, Pages 1341-1346.e1
<40 years old 1:10 dead by 10 years
Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults Ismail Bouhout, et al JTCVS 2014 Volume 148, Issue 4, Pages 1341-1346.e1
1:4 will experience MAPE by 10 yearsMajor adverse
prosthetic eventsEndocarditisThrombosisDysfunctionHemorrhage
Thromboembolism
The Perimount Valve in the Aortic Position: Twenty-
Year Experience With Patients Under 60 Years OldJ. Forillo et al Ann Thorac Surg 2014;97:1526–32
70% by 20 years will have a prosthetic dysfunction
Between 40-60 years of age
Twenty-year durability of the aortic Hancock II
bioprosthesis in young patients: is it durable enough?Dai Une Marc Ruel Tirone E. David
European Journal of Cardio-Thoracic Surgery 2014;46:825–830,1: 5 dead within 10 years
Most 50-60 and 30% below 50
OCC initial experience Valve Repair
15 patients (17-68)
3 Marfan’s (one with Barlow’s) (HAART + sSR +AscAR )
3 A root aneurysm – symmetric (HAART + sSR +AscAR )
1 A. Root + Asc.Ao Aneurysm (HAART + AscAR )
1 Asc. Ao An. & cusp prolapse & fenestration (HAART 300)
3 BAV (2 leaflet repair, 1 sub/com)
2 A root aneurysm – asymmetric (asym. Root Remodelling)
1 An.AscAo and single sinus dilatation (sSR +AscAR )
1 A Root aneurysm A. Root Remodelling
Worries
• RCA ostium adjacent to R-N comissure
• Asymmetric sinuses
• Intermediate type BAV- Non- Conjoined <160o
• R. sinus with high A-V junction
• Not available HAART 200 in Europe
• Glutaraldehyde availability and standardized protocol
New Applications
“Intermediate-Type” BAV
OCC initial experience Valve Repair
OCC initial experience Valve Repair
OCC initial experience Valve Repair
OCC initial experience Valve Repair
OCC initial experience Valve Repair
OCC initial experience Valve Repair
OCC initial experience Valve Repair
OCC initial experience Valve Repair
OCC initial experience Valve Repair
Aortic Valve Repair Important Considerations
1. Managing Asymmetry
2. Liberal Downsizing
3. Position Ring Post Deep into Sub-
Commissural Space
4. Uniform Lateral Suture Fixation
Aortic Valve Repair
Tri-Leaflet and Bicuspid Ring Annuloplasty
Reconstruction of Leaflet Defects
Repair
Repair
New Applications
“Intermediate-Type” BAV
New Applications
Endocarditis
Future Applications
Rheumatic and Calcified Stenotic Valves
Stented Tri-Leaflet Autologous
Pericardial Aortic Valve
Ozaki Procedure
Tri-Leaflet Glutaraldehyde-Fixed
Autologous Pericardial Aortic Valve
!
New Applications
Valve-in-RingProcedures
New Applications
Minimally Invasive Aortic Valve Repair
Courtesy H J Schaefers