# Aortic valve repair with annuloplasty

## TL;DR

This paper reports on the safety and effectiveness of aortic valve repair using an external Teflon ring annuloplasty over a nine-year period.

## Contribution

The study provides long-term outcomes of aortic valve repair with annuloplasty and identifies factors associated with recurrence of severe aortic regurgitation.

## Key findings

- Aortic valve repair with external Teflon ring annuloplasty showed 8-year overall survival of 97.4%.
- Recurrence of severe AR was predicted by an enlarged aortic annulus and non-routinary use of cusp caliper.
- The procedure had 100% freedom from thromboembolism and 98.3% freedom from endocarditis at 8 years.

## Abstract

Aortic valve repair procedures for aortic valve regurgitation have been progressively adopted in the last decades. We analysed our results with an external ring annuloplasty and/or leaflet repair.

From April 2014 to December 2023, 61 consecutive patients underwent aortic valve repair with external Teflon ring annuloplasty. The external ring was made of an 8–9 mm Teflon strip, to reduce the annulus diameter between 21 and 23 mm. Cusp effective height (eH) was assessed with a caliper (not used before 2018), and any cusp prolapse was corrected by free margin plication, to obtain a 9–10 mm eH for all cusps.

Patients (72.1%) had severe aortic regurgitation (AR), and associated supracoronary aneurysm repair was performed in 42.6%. No operative death occurred; residual AR more-than-moderate was present in one patient only. The 8-year overall survival was 97.4 ± 2.6%, freedom from endocarditis 98.3 ± 1.7% and freedom from thromboembolism 100%. Recurrence of severe AR with need for reoperation was predicted by the presence of a particularly enlarged aortic annulus (≥28 mm, P < 0.01) and the non-routinary use of cusp caliper (P = 0.03).

The external Teflon ring annuloplasty appears a safe procedure with high overall survival, freedom from endocarditis and freedom from thromboembolism at 10 years. Recurrence of severe AR could be related to patient selection and learning curve.

In the past 20 years, reconstructive techniques for addressing aortic regurgitation (AR), whether accompanied by an aortic root aneurysm or not, have emerged as a viable and increasingly popular alternative to valve replacement [1, 2].