Aortic Valve Anuluplasty System
Designed by Khalil Fattouch, MD, PhD.
Aortic valve What we learn from the mitral valve?
Surgeons are not concerned about the valve, but with the
Aortic Functional Unit
Aortic anulus Cusps Valsalva sinus Commissures Sinotubular Junction Ascending aorta
Relationship between severals Aortic Root Components are important for normal valve function
AA > STJ (10-15%)
Coaptation high = 0.5-0.8 cm
High of opened leaflet = 70% of sinus
Tipo Ia- STJ Dilation
Functional Classification of AR
Tipo I:
Normal leaflet motion
Tipo II:
Excessive leaflets motion
Tipo III:
Restrictive leaflets motion
• Ia – STJ dilation
• Ib – dilation of valsalva sinuses
• Ic – FAA dilation
• Id – Perforation
• Prolapse
• Dissection
• Calcification
• Cusp fusion
Lesson from mitral valve repair
Anuluplasty is a fundamental step in mitral valve repair:
re-shape the anulus stabilize the repair improve long term results
Aortic AnulusWhat is the true valve anulus ?
Commissures
Nadir
Aortic Anulus
Interleaflet triangles
Basal circumference
Sinutubular ridge
commissures
Functional Aortic Anulus
FAA = (Anatomical anulus + STJ)
Ring for aortic valve repairmust:
1. re-shape the functional aortic anulus
2. Stabilize the continuity between the aortic valve annulus and the STJ.
The second point of viewInterleaflets Triangles
Are essentials for normal leaflets opening and normal distribuition of stress
Annulus
Mechanism of Opening:sequence of leaflets opening
Stellate orifice
Small triangle
Triangle
Circular orifice
From stellate orifice to small triangle
Increase in ventricular pressure through the interleaflet triangle causes an increase of diameter at the commissures (STJ) before the valve opens
Answer to the first paradox: “the valve opens before the presence of forward flow”
The second objective?
The ring for aortic valve repair must,
Leave the commissures and the interleaflets triangle free to move
during the cardiac cicle, that is essentialfor a normal leaflets motion and stress
distribuition
Today, what we do in aortic valve repair?Subcommissures plasty
Our idea, to re-shape the functional aortic anulus and preserve aortic leaflets motion
Re-shape the STJ
Re-shape the anatomical anulus
From inside LV outflow tract
From outside the aorta
a
b
Suture TechniqueLeave free the interleaflets triangles
Re-shape the sinotubular junction
Applied outside to the aorta at the level of the STJ and sutured to the aorta with the same suture line when we close the aortotomy using 4-0 prolene.
The 3 crown were sutured at the level of commissures and fixed to the internal ring using the same ticron U-stitch used previously.
The D shape of the annulus avoid blood turbolence under the aortic valve
Flexible zoneFree from suture
Suture Technique
Objective Re-shape and Stabilize the functional aortic annulus
Undersize the anatomical aortic annulus from inside ofLV outflow tract (improve leaflets coaptation).
Leave the interleaflets triangles and commissures free to move that is mandatory for a normal leaflets stress distribuition and motion (opening).
An external application of a ring may lead to cusps prolapse.
Thank for ……