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• W4213217557 abstract "Central MessageAortic valve reimplantation can be adapted to given cusp sizes by calculated reduction of annular diameter.See Article page 27. Aortic valve reimplantation can be adapted to given cusp sizes by calculated reduction of annular diameter. See Article page 27. The goal of valve-preserving root replacement is the restoration of normal aortic valve form, coaptation, and thus function to achieve the best valve durability. To achieve this, the operation must accommodate the geometry of the cusps, which may differ in size. Several studies have shown that effective cusp height1Schäfers H.J. Bierbach B. Aicher D. A new approach to the assessment of aortic cusp geometry.J Thorac Cardiovasc Surg. 2006; 132: 436-438Google Scholar is a good indicator of valve configuration. In normal aortic valves, it has a close correlation with geometric cusp height.2Schäfers H.J. Schmied W. Marom G. Aicher D. Cusp height in aortic valves.J Thorac Cardiovasc Surg. 2013; 146: 269-274Google Scholar,3De Kerchove L. Momeni M. Aphram G. Watremez C. Bollen X. Jashari R. et al.Free margin length and coaptation surface area in normal tricuspid aortic valve: an anatomical study.Eur J Cardiothorac Surg. 2018; 53: 1040-1048Google Scholar To achieve normal aortic configuration with adequate coaptation through valve-preserving surgery, modification of annular and sinotubular dimensions may be helpful.4Marom G. Haj-Ali R. Rosenfeld M. Schäfers H.J. Raanani E. Aortic root numeric model: annulus diameter prediction of effective height and coaptation in post-aortic valve repair.J Thorac Cardiovasc Surg. 2013; 145: 406-411Google Scholar In particular, reduction of annular size can improve coaptation. Aortic valve reimplantation is probably the most popular form of valve-preserving aortic replacement; it stabilizes the aortic root at annular and sinotubular level. Different graft-sizing methods are employed,5David T.E. Feindel C.M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta.J Thorac Cardiovasc Surg. 1992; 103 (discussion 622): 617-621Google Scholar,6de Kerchove L. Boodhwani M. Glineur D. Noirhomme P. El Khoury G. A new simple and objective method for graft sizing in valve-sparing root replacement using the reimplantation technique.Ann Thorac Surg. 2011; 92: 749-751Google Scholar even though many surgeons simply use a 30-mm graft. Both annular and sinotubular dimensions will be more or less identical if a tubular graft is used. The given cusp sizes, however, may require size adaptation, ie, further reduction of annular size to improve valve coaptation. As yet, this is done based on subjective surgical judgment or involuntarily on tying the basal sutures. The current proposition7Tanaka H. Nomura Y. Murakami H. Miyahara S. A simplified approach to determine the ventriculoaortic junction diameter in the reimplantation procedures.J Thorac Cardiovasc Surg Tech. 2022; 12: 27-31Google Scholar takes a controlled approach to annular size adaptation, using a simple formula with geometric cusp height as the determinant. Effective height is set at 45% of geometric height, as found in normal aortic valves.3De Kerchove L. Momeni M. Aphram G. Watremez C. Bollen X. Jashari R. et al.Free margin length and coaptation surface area in normal tricuspid aortic valve: an anatomical study.Eur J Cardiothorac Surg. 2018; 53: 1040-1048Google Scholar Annular size is predicted and controlled by tying the lower suture line around a Hegar dilator of the desired size. Using their formula, the colleagues could achieve normal aortic valve form and function in a reproducible fashion.7Tanaka H. Nomura Y. Murakami H. Miyahara S. A simplified approach to determine the ventriculoaortic junction diameter in the reimplantation procedures.J Thorac Cardiovasc Surg Tech. 2022; 12: 27-31Google Scholar While the results are early and need to be confirmed by more experience and other surgeons, this approach appears as an interesting modification of the standard operation toward a geometry-based reconstruction of the aortic valve. It may help others to improve the results of aortic valve reimplantation, even in the absence of extensive personal experience. A simplified approach to determine the ventriculoaortic junction diameter in the reimplantation proceduresJTCVS TechniquesVol. 12PreviewIn aortic valve–sparing procedures, sufficient effective height (EH) is essential for long-term aortic valve durability.1 The plication of the nodule of Arantius (central plication) and the free margin resuspension with polytetrafluoroethylene sutures are performed to obtain sufficient EH, but overcorrection brings the immobility of the cusp and the gap in the central coaptation zone. In the reimplantation procedure, reducing the ventriculoaortic junction (VAJ) diameter with the proximal suture line is another option for increasing the coaptation height2; however, the degree of the reduction must be decided at the beginning of the procedure before the cusp configuration is completed. Full-Text PDF Open Access" @default.
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• W4213217557 date "2022-02-01" @default.
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• W4213217557 title "Commentary: Standardized adaptation of aortic valve reimplantation to cusp geometry" @default.
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• W4213217557 doi "https://doi.org/10.1016/j.xjtc.2022.02.011" @default.
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