Reconstruction of Complex Proximal Aortic Dissections with Aortic Insufficiency Using Aortic Ring Annuloplasty

Ascending aortic dissections often involve the aortic root and create aortic valve insufficiency. Prosthetic valve replacement in this setting yields inferior long-term results. Reparative management by commissural resuspension has been associated with an incidence of valve and sinus deterioration over time. The background of aortic ring annuloplasty is presented, as well as rationale for application to aortic root dissection. A video of a representative case with Loeyz-Dietz syndrome and extensive aortic root dissection is presented. Using a combination of aortic ring annuloplasty to reestablish root geometry and aggressive remodeling replacement of involved sinuses, destroyed root structures and aortic competence routinely can be re-established with a simple and safe approach. More cases and longer-term follow-up will be needed for full validation.

References

1. Rankin JS, Bone MC, Fries PM, Aicher D, Schafers HJ, Crooke PS. A refined hemispheric model of normal human aortic valve and root geometry. J Thorac Cardiovasc Surg. 2013;146:103-9.

2. Rankin JS, Wei LM, Downey RS, Si M-S, Gerdisch MW, Kupferschmid JP, et al. Aortic Valve Repair Using Geometric Ring Annuloplasty. Operative Techniques in Thoracic and Cardiovascular Surgery. 2021;26:173-83.