- Resource Type:
- Presentation
217. Repair Of Neo-aortic Valve Insufficiency Following The Ross Procedure With Geometric Ring Annuloplasty
May 17, 2022
James Quintessenza , Invited Discussant , All Children's Hospital
Erle Austin , Case Video Presenter , Norton Children's Hospital
102nd Annual Meeting, Boston, MA, USA
Hynes Convention Center, Room 210
Abstract
Objective: Late reoperation for autograft dilatation and neo-aortic valve insufficiency following the Ross procedure usually includes aortic root replacement (Bentall or valve sparing). While autograft dilatation contributes to insufficiency, leaflet pathology is not uncommon. We present neo-aortic valve repair of an intermediate-type bicuspid valve with the use of tri-leaflet aortic ring annuloplasty, along with replacement of the non-coronary sinus and supra-coronary autograft with a Dacron graft.
Case Video Summary: A 9 year-old male had a Ross procedure 4 years earlier for bicuspid aortic valve disease. Lately, he developed heart failure, worsening severe neo-aortic Insufficiency, thickened leaflets, a 3.1 cm annulus, and neo-aortic root dilatation. At surgery, the aorta was transected and suspended at the commissures. The neo-aortic valve seemed to have two partially fused leaflets, making it an intermediate-type bicuspid valve. Leaflet sizing revealed a 21 mm non-fused leaflet and 19 mm for each fused leaflet. A 19 mm tri-leaflet aortic annuloplasty ring was selected, and 3 Cabrol-like stitches buried the ring posts into the sub-commissural triangles. Then, 3 looping sutures anchored each ring sinus segment to the annulus. All sutures were tied and laterally fixed. The leaflets then were assessed and had different effective heights. The ultrasonic aspirator helped soften the thickened cleft tissue in the fused leaflet, and all leaflets were plicated to raise and equalize effective heights until good verticality and coaptation were achieved. The noncoronary sinus and supra-coronary autograft wall were replaced with a 26 mm Dacron graft. Echocardiogram showed trivial to mild neo-aortic valve regurgitation and a mean systolic gradient of 16 mm Hg. Recovery was noneventful.
Conclusions: The approach of aortic ring annuloplasty and leaflet reconstruction facilitates repair of the dysfunctional neo-aortic valve, stabilizes the annulus, and simplifies the resection of the dilated neo-aortic root.
Bahaaldin Alsoufi (1), J. Scott Rankin (2), Marc Gerdisch (3), Erle Austin (1), (1) Norton Children's Hospital, Louisville, KY, (2) West Virginia University, Nashville, TN, (3) Franciscan Health Heart Center, Indianapolis, IN
James Quintessenza
Invited Discussant
Dr. Quintessenza is the co-director of the Heart Institute and Professor and chief of cardiovascular surgery at Johns Hopkins All Children’s Hospital.
Erle Austin
Case Video Presenter
Native of Virginia, graduate of Dartmouth College (1970) and Harvard Medical School (1974) with general and thoracic surgical training at Duke University Medical Center (1974-85)and fellowship in pediatric and congenital heart surgery at Boston Children's Hospital (1985). Began career at East Carolina University Medical Center in Greenville, NC. Recruited to University of Louisville in 1989 where he led the congenital heart surgery program until steppring down in 2018 as chief but remaining professor and vice-chairman of Department of Cardiovascular and Thoracic Surgery at the University of Louisville. As of July 2021 he is Professor Emeritus.
Dr. Austin has been an active member of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery for which he served as chairman of its membership committee for successive tenures. He has also been an active participant in the Congenital Heart Surgeons’ Society, chairing multiple committees and serving as its President from 2010 to 2012. Dr. Austin has authored or coauthored over 150 journal articles, book chapters, and books, and currently sits on the editorial boards of the Journal of Thoracic and Cardiovascular Surgery and the World Journal of Pediatric and Congenital Heart Surgery, and served as Co-Editor of Seminars in Thoracic and Cardiovascular Surgery from 2014 - 2020.. He has also served as a consultant to the Circulatory System Devices Panel of the FDA.