Aortic valve repair with annuloplasty

OBJECTIVE: 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. METHODS: 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 to 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. RESULTS: 72.1% of patients had severe aortic regurgitation, associated supracoronary aneurysm repair was performed in 42.6%. No operative death occurred, residual AR more-than-moderate was present in one patient only. Eight years overall survival was 97.4 ± 2.6 %, freedom from endocarditis 98.3 ± 1.7 % and freedom from thromboembolism 100%. Recurrence of severe aortic regurgitation with need for reoperation was predicted by the presence of particularly enlarged aortic annulus (≥ 28mm, p< 0.01) and the non-routinary use of cusp caliper (p = 0.03). CONCLUSIONS: The external Teflon ring annuloplasty appears a safe procedure with high overall survival, freedom from endocarditis and freedom from thromboembolism at ten years. Recurrence of severe aortic regurgitation could be related to patient selection and learning curve.