Aortic valve repair for aortic regurgitation and preoperative echocardiographic assessment
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Aortic valvuloplasty (AVP) has been performed less frequently than mitral valvuloplasty. The survival benefit of AVP over replacement has been demonstrated. Therefore, standardization of AVP is crucial for its widespread adoption. The hemodynamic advantage of AVP of preserving the native aortic valve may be one reason for the survival benefit. Recent guidelines still recommend AVP in selected cases compared with the less restricted recommendation for mitral valvuloplasty, although recent studies have proposed earlier indication for surgical intervention. Indication for aortic root replacement is also still conservative, especially in Japan. However, more liberal root replacement should be recommended for better repair when AVP is indicated. Theoretically, all aortic regurgitation lesions can be repaired with acceptable durability. However, restricted cusp should be extended by a pericardial patch, which itself has emerged as a risk of recurrence. Therefore, indications for aortic regurgitation for type III lesions should be determined carefully. Special consideration is crucial for bicuspid aortic valve repair; prevention of postoperative stenosis is especially important. Arrangement of the commissure position is the most important consideration for this purpose, although it remains controversial. Therefore, detailed diagnosis is important in planning AVP, and echocardiography plays a key role in this process.
KeywordsAortic valve repair Valve-preserving root replacement Echocardiography Surgical indication Operative technique
The author would like to thank Dr. Miura, Shizuoka City Shizuoka Hospital, and Dr. Hama, Saku Central Hospital Advanced Care Center, for sharing intraoperative and echocardiographic findings.
Compliance with ethical standards
Conflict of interest
The author declares that there are no conflicts of interest related to this study.
- 1.Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Okumura M, Doki Y, et al. Thoracic and cardiovascular surgery in Japan during: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2014;2016(64):665–97.Google Scholar
- 4.Stamou SC, Williams ML, Gunn TM, et al. Aortic root surgery in the United States: a report from the society of thoracic surgeons database. J Thorac Cardiovasc Surg. 2015;149(116–22):e4.Google Scholar
- 5.Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Kuwano H, Okumura M, et al. Thoracic and cardiovascular surgery in Japan during, annual report by The Japanese association for thoracic surgery. Gen Thorac Cardiovasc Surg. 2012;2014(62):734–64.Google Scholar
- 10.Kunihara T. Toward standardization of valve-sparing root replacement and annuloplasty. Gen Thorac Cardiovasc Surg. (in press).Google Scholar
- 16.Graeter TP, Fries R, Aicher D, Reul H, Schmitz C, Schäfers HJ. In-vitro comparison of aortic valve hemodynamics between aortic root remodeling and aortic valve reimplantation. J Heart Valve Dis. 2006;15:329–35.Google Scholar
- 17.Zeeshan A, Idrees JJ, Johnston DR, Rajeswaran J, Roselli EE, Soltesz EG, Gillinov AM, Griffin B, Grimm R, Hammer DF, Pettersson GB, Blackstone EH, Sabik JF 3rd, Svensson LG. Durability of aortic valve cusp repair with and without annular support. Ann Thorac Surg. 2018;105:739–48.CrossRefGoogle Scholar
- 19.Vohra HA, Whistance RN, de Kerchove L, et al. Influence of higher valve gradient on long-term outcome after aortic valve repair. Ann Cardiothorac Surg. 2013;2:30–9.Google Scholar
- 20.Nishimura RA, Otto CM, Bonow RO, ACC, AHA Task Force Members, et al. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: executive summary: a report of the American college of cardiology/american heart association task force on practice guidelines. Circulation. 2014;2014(129):2440–92.CrossRefGoogle Scholar
- 21.Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52:616–64.CrossRefGoogle Scholar
- 27.ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease representative members, 2014 AHA/ACC guideline for the management of patients with valvular heart disease representative members, Nishimura RA, Bonow RO, Guyton RA, Hiratzka LF, Creager MA, Isselbacher EM, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American college of cardiology/american heart association task force on clinical practice guidelines. J Thorac Cardiovasc Surg. 2016;151:959–66.CrossRefGoogle Scholar
- 28.Erbel R, Aboyans V, Boileau C, ESC Committee for Practice Guidelines, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology (ESC). Eur Heart J. 2014;35:2873–926.CrossRefGoogle Scholar
- 29.Guidelines for surgical and interventional treatment of valvular heart disease JCS 2012. http://www.j-circ.or.jp/guideline/pdf/JCS2012_ookita_h.pdf.
- 39.David TE, Feindel CM. An aortic-valve sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–22.Google Scholar
- 40.Sarsam MA, Yacoub M. Remodeling of the aortic anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.Google Scholar
- 44.Cabrol C, Cabrol A, Guiraudon G, et al. Treatment of aortic insufficiency by means of aortic annuloplasty. Arch Mal Coeur Vaiss. 1966;59:1305–12.Google Scholar
- 47.Izumoto H, Kawazoe K, Kawase T, et al. Subvalvular circular annuloplasty as a component of aortic valve repair. J Heart Valve Dis. 2002;11:383–5.Google Scholar
- 52.Trusler GA, Moses CAF, Kid BSL. Repair of ventricular septal defect with aortic insufficiency. J Thorac Cardiovasc Surg. 1973;66:394–403.Google Scholar
- 54.Carpentier A. Cardiac valve surgery: the French correction. J Thorac Cardiovasc Surg. 1983;86:323–37.Google Scholar