Ring annuloplasty for mitral valve repair became the gold standard by virtue of assuring a certain durable degree of leaflet coaptation. Dr. Tirone David and other advocates have proven indirectly that aortic valve repair with a ring, as part of valve sparing procedures, can also provide a durable degree of leaflet coaption. While internal aortic valve annuloplasty rings are not currently commercially available, the author and others have adapted a simple Dacron band for use in aortic valve annuloplasty at the level of the virtual basal ring during isolated valve repair, without formal root replacement. It is anticipated by the author that stabilization of the virtual basal ring will accomplish for aortic valve repair what has already been achieved in establishing mitral valve repair as the gold standard.
This technique is uncomplicated and very well explained. Excellent Video & Explanation. Congratulations with the clinical outcome.
This tehnique has been described by Lansac and colleagues in “An expansible aortic ring for a physiological approach to conservative aortic valve surgery”.J Thorac Cardiovasc Surg. 2009 Sep;138(3):718-24.
“Functionnal or Physological Restoration: That ‘s the Question! ”
There is no doubt that some kind of so-called “annuloplaty” should be part of aortic valve repairing procedure. But let classifying properly different kinds of these annuloplasty techniques.
Indeed what author presents in this video acts on one component of complex three dimensionnal aortic valve annulus: the Ventriculo-Aortic Junction, therefore, I would consider the present technique or its equivalent as “VAJ Stabilization”. The latter is exactly what I consider as functional repairing as it leads to acceptable results such as in mitral valve repairing. Nevertheless, functional repairig alters the natural functional anatomy. For example, iatrogenic restriction of the posterior leaflet or occurence of SAM by undersizing mitral annuloplasty may be some examples. In the matter of aortic valve, VAJ stabilization canceals the three dimensional structure of the basal attachment of the aortic leaflets especially the natural crescent shape (or double bended) which garants the full expension of the aortic leaflets. A direct transcription of such alteration may be induced leafleats prolapse, as it is reported by a higher rate of leaflet repairig by teams using different kinds of internal or external VAJ stabilization.
The second category of annuloplasty are devices attempted at restoring and reinforcing the natural three dimensional struture of the aortic root that I would consider as “Geo-Spatial Stabilization” and physiological repairing. I deeply conveiced that many leaflet prolapses can be simply adressed by Geo-Spatial Stabilization even in bicuspid aortic valves. The newer three dimensional aortic root rings will shed lights on this issue in the incoming years.
Aside such intelectual exchanges that are basis of mutual progress, I have really enjoyed the author technique and his dexterity, a techinque that I will surely use.
Cordially