Variations and Outcomes of Annuloplasty

  • Takashi KuniharaEmail author


Although annuloplasty for the aortic valve has been performed for quite a while, it has not been standardized for various reasons. However, in recent years, aortic valvuloplasty has aggressively been performed, and as it becomes clear that annular expansion is a risk factor for the recurrence of aortic regurgitation, annuloplasty is being recognized as an important option and various alternatives have been proposed. This section organizes and classifies the various types of annuloplasty, adds an overview, and clarifies their advantages and disadvantages.


  1. 1.
    Taylor WJ, Thrower WB, Black H, Harken DE. The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg. 1958;35:192–205.PubMedGoogle Scholar
  2. 2.
    Schneider U, Aicher D, Miura Y, Schäfers HJ. Suture Annuloplasty in Aortic Valve Repair. Ann Thorac Surg. 2016;101:783–5.CrossRefGoogle Scholar
  3. 3.
    Cabrol C, Cabrol A, Guiraudon G, Bertrand M. Treatment of aortic insufficiency by means of aortic annuloplasty. Arch Mal Coeur Vaiss. 1966;59:1305–12.PubMedGoogle Scholar
  4. 4.
    Duran CG. Reconstructive techniques for rheumatic aortic valve disease. J Card Surg. 1988;3:23–8.CrossRefGoogle Scholar
  5. 5.
    Cosgrove DM, Rosenkranz ER, Hendren WG, Bartlett JC, Stewart WJ. Valvuloplasty for aortic insufficiency. J Thorac Cardiovasc Surg. 1991;102:571–6.PubMedGoogle Scholar
  6. 6.
    Kollar A. Valve-sparing reconstruction within the native aortic root: integrating the Yacoub and the David methods. Ann Thorac Surg. 2007;83:2241–3.CrossRefGoogle Scholar
  7. 7.
    Mangini A, Lemma MG, Soncini M, Votta E, Contino M, Vismara R, et al. The aortic interleaflet triangles annuloplasty: a multidisciplinary appraisal. Eur J Cardiothorac Surg. 2011;40:851–7.PubMedGoogle Scholar
  8. 8.
    Carpentier A. Cardiac valve surgery—the “French correction”. J Thorac Cardiovasc Surg. 1983;86:323–37.PubMedGoogle Scholar
  9. 9.
    Haydar HS, He GW, Hovaguimian H, McIrvin DM, King DH, Starr A. Valve repair for aortic insufficiency: surgical classification and techniques. Eur J Cardiothorac Surg. 1997;11:258–65.CrossRefGoogle Scholar
  10. 10.
    Schöllhorn J, Rylski B, Beyersdorf F. Aortic valve annuloplasty: new single suture technique. Ann Thorac Surg. 2014;97:2211–3.CrossRefGoogle Scholar
  11. 11.
    David TE. Aortic root aneurysms: remodeling or composite replacement? Ann Thorac Surg. 1997;64:1564–8.CrossRefGoogle Scholar
  12. 12.
    Hahm SY, Choo SJ, Lee JW, Seo JB, Lim TH, Song JK. Novel technique of aortic valvuloplasty. Eur J Cardiothorac Surg. 2006;29:530–6.CrossRefGoogle Scholar
  13. 13.
    Bae JM, Shin E, Heo DS. Safety of comprehensive aortic root and valve repair surgery: a retrospective outcomes research by national evidence-based health care collaborating agency, Korea. Korean Circ J. 2012;42:769–71.CrossRefGoogle Scholar
  14. 14.
    Duran CM, Gallo R, Prabhakar G, Kumar N, Hainau B. New prosthetic ring for aortic valve annuloplasty. Cardiovasc Surg. 1993;1:166–71.PubMedGoogle Scholar
  15. 15.
    Schomburg JL, Lahti MT, Ruth GR, Bianco RW. Internal aortic annuloplasty: a novel technique. J Investig Surg. 2011;24:222–6.CrossRefGoogle Scholar
  16. 16.
    Rankin JS, Conger JL, Tuzun E, Winkler JA, Harms KM, Beavan LA, et al. In vivo testing of an intra-annular aortic valve annuloplasty ring in a chronic calf model. Eur J Cardiothorac Surg. 2012;42:149–54.CrossRefGoogle Scholar
  17. 17.
    Mazzitelli D, Pfeiffer S, Rankin JS, Fischlein T, Choi YH, Wahlers T, et al. A regulated trial of bicuspid aortic valve repair supported by geometric ring annuloplasty. Ann Thorac Surg. 2015;99:2010–6.CrossRefGoogle Scholar
  18. 18.
    Reimold SC, Aranki SF, Caguioa ES, Solomon SD, Birjiniuk V, Cohn LH, et al. An external aortic root device for decreasing aortic regurgitation: in vitro and in vivo animal studies. J Card Surg. 1994;9:304–13.CrossRefGoogle Scholar
  19. 19.
    Kawazoe K, Izumoto H, Satoh Y, Eishi K, Ishibashi K. Annuloaortic repair in the treatment of aortic regurgitation and aortic root pathology. Surg Today. 2001;31:27–31.CrossRefGoogle Scholar
  20. 20.
    Izumoto H, Kawazoe K, Kawase T, Kim H. Subvalvular circular annuloplasty as a component of aortic valve repair. J Heart Valve Dis. 2002;11:383–5.PubMedGoogle Scholar
  21. 21.
    Fattouch K, Sampognaro R, Speziale G, Ruvolo G. New technique for aortic valve functional annulus reshaping using a handmade prosthetic ring. Ann Thorac Surg. 2011;91:1154–8.CrossRefGoogle Scholar
  22. 22.
    Gogbashian A, Ghanta RK, Umakanthan R, Rangaraj AT, Laurence RG, Fox JA, et al. Correction of aortic insufficiency with an external adjustable prosthetic aortic ring. Ann Thorac Surg. 2007;84:1001–5.CrossRefGoogle Scholar
  23. 23.
    Lansac E, Di Centa I, Sleilaty G, Lejeune S, Khelil N, Berrebi A, et al. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg. 2016;50:350–60.CrossRefGoogle Scholar
  24. 24.
    Lansac E, Di Centa I, Sleilaty G, Lejeune S, Berrebi A, Zacek P, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033–42.CrossRefGoogle Scholar
  25. 25.
    Lansac E, Bouchot O, Arnaud Crozat E, Hacini R, Doguet F, Demaria R, et al. Standardized approach to valve repair using an expansible aortic ring versus mechanical Bentall: Early outcomes of the CAVIAAR multicentric prospective cohort study. J Thorac Cardiovasc Surg. 2015;149:S37–45.CrossRefGoogle Scholar
  26. 26.
    Scharfschwerdt M, Pawlik M, Sievers HH, Charitos EI. In vitro investigation of aortic valve annuloplasty using prosthetic ring devices. Eur J Cardiothorac Surg. 2011;40:1127–30.PubMedGoogle Scholar
  27. 27.
    Richardt D, Bucsky B, Charitos EI, Sievers HH, Scharfschwerdt M. A novel rigid annuloplasty ring for aortic valve reconstruction: an in vitro investigation. Ann Thorac Surg. 2014;97:811–5.CrossRefGoogle Scholar
  28. 28.
    Lansac E, Di Centa I, Bonnet N, Leprince P, Rama A, Acar C, et al. Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure? Eur J Cardiothorac Surg. 2006;29:537–44.CrossRefGoogle Scholar
  29. 29.
    Schäfers HJ, Raddatz A, Schmied W, Takahashi H, Miura Y, Kunihara T, et al. Reexamining remodeling. J Thorac Cardiovasc Surg. 2015;149:S30–6.CrossRefGoogle Scholar
  30. 30.
    Kunihara T, Aicher D, Rodionycheva S, Groesdonk HV, Langer F, Sata F, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.CrossRefGoogle Scholar
  31. 31.
    Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123:178–85.CrossRefGoogle Scholar
  32. 32.
    Khelil N, Sleilaty G, Palladino M, Fouda M, Escande R, Debauchez M, et al. Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg. 2015;99:1220–6.CrossRefGoogle Scholar
  33. 33.
    de Kerchove L, Jashari R, Boodhwani M, Duy KT, Lengelé B, Gianello P, et al. Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg. 2015;149:425–33.CrossRefGoogle Scholar
  34. 34.
    Schneider U, Schmied W, Aicher D, Giebels C, Winter L, Schäfers HJ. Sinus plication to improve valve configuration in bicuspid aortic valve repair-early results. Ann Thorac Surg. 2017;103:580–5.CrossRefGoogle Scholar
  35. 35.
    Holubec T, Higashigaito K, Belobradek Z, Dergel M, Harrer J, Alkadhi H, et al. An expansible aortic ring in aortic root Remodeling: exact position, pulsatility, effectiveness, and stability in three-dimensional CT study. Ann Thorac Surg. 2017;103:83–90.CrossRefGoogle Scholar
  36. 36.
    de Kerchove L, Vismara R, Mangini A, Fiore GB, Price J, Noirhomme P, et al. In vitro comparison of three techniques for ventriculo-aortic junction annuloplasty. Eur J Cardiothorac Surg. 2012;41:1117–23.CrossRefGoogle Scholar
  37. 37.
    Leyh RG, Schmidtke C, Sievers HH, Yacoub MH. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999;100:2153–60.CrossRefGoogle Scholar
  38. 38.
    Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg. 2000;119:975–82.CrossRefGoogle Scholar
  39. 39.
    Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg. 2017;103:504–10.CrossRefGoogle Scholar
  40. 40.
    de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde JL, Noirhomme P, et al. Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg. 2011;142:1430–8.CrossRefGoogle Scholar
  41. 41.
    Vohra HA, Whistance RN, de Kerchove L, Glineur D, Noirhomme P, El Khoury G. Influence of higher valve gradient on long-term outcome after aortic valve repair. Ann Cardiothorac Surg. 2013;2:30–9.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Navarra E, El Khoury G, Glineur D, Boodhwani M, Van Dyck M, Vanoverschelde JL, et al. Effect of annulus dimension and annuloplasty on bicuspid aortic valve repair. Eur J Cardiothorac Surg. 2013;44:316–22.CrossRefGoogle Scholar
  43. 43.
    Vallabhajosyula P, Komlo CM, Szeto WY, Rhode T, Menon R, Desai ND, et al. Aortic annulus diameter affects durability of the repaired bicuspid aortic valve. J Heart Valve Dis. 2015;24:412–9.PubMedGoogle Scholar
  44. 44.
    de Kerchove L, Mastrobuoni S, Boodhwani M, Astarci P, Rubay J, Poncelet A, et al. The role of annular dimension and annuloplasty in tricuspid aortic valve repair. Eur J Cardiothorac Surg. 2016;49:428–37.CrossRefGoogle Scholar
  45. 45.
    Mazzitelli D, Fischlein T, Rankin JS, Choi YH, Stamm C, Pfeiffer S, et al. Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg. 2016;49:987–93.CrossRefGoogle Scholar
  46. 46.
    Cameron D. Why can’t the aortic valve be more like the mitral? Eur J Cardiothorac Surg. 2016;49:994.CrossRefGoogle Scholar
  47. 47.
    Izumoto H, Kawazoe K, Oka T, Ishibashi K, Yamamoto H, Yamamoto F. Leaflet suspension and subvalvular annuloplasty in aortic valve prolapse. Asian Cardiovasc Thorac Ann. 2009;17:278–81.CrossRefGoogle Scholar
  48. 48.
    Kazui T, Tsuboi J, Izumoto H, Nakajima T, Ishihara K, Kawazoe K. Aortic root remodeling with aortic annuloplasty: mid-term results. Circ J. 2007;71:207–10.CrossRefGoogle Scholar
  49. 49.
    Schäfers HJ. Aortic annuloplasty: the panacea of valve-preserving aortic replacement? J Thorac Cardiovasc Surg. 2017;153:1043–4.CrossRefGoogle Scholar
  50. 50.
    Matsumori M, Tanaka H, Kawanishi Y, Onishi T, Nakagiri K, Yamashita T, et al. Comparison of distensibility of the aortic root and cusp motion after aortic root replacement with two reimplantation techniques: Valsalva graft versus tube graft. Interact Cardiovasc Thorac Surg. 2007;6:177–81.CrossRefGoogle Scholar
  51. 51.
    Wuliya M, Sleilaty G, Di Centa I, Khelil N, Berrebi A, Czitrom D, et al. An expansible aortic ring to preserve aortic root dynamics after aortic valve repair. Eur J Cardiothorac Surg. 2015;47:482–90.CrossRefGoogle Scholar
  52. 52.
    Basmadjian L, Basmadjian AJ, Stevens LM, Mongeon FP, Cartier R, Poirier N, et al. Early results of extra-aortic annuloplasty ring implantation on aortic annular dimensions. J Thorac Cardiovasc Surg. 2016;151:1280–5.CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Cardiac SurgeryThe Jikei University School of MedicineTokyoJapan

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