Abstract 12741: Impact of Sleeve Procedure on Commissure Height During Aortic Valve Repair

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A12741
• Main Authors: Obase, Kikuko, Miura, Takashi, Miyanaga, Tatsuya, Takura, Masayuki, Taguchi, Hiroko, Shimada, Takashi, Tasaki, Yuichi, Yokose, Shogo, Nakaji, Shun, Matsumaru, Ichiro, Eishi, Kiyoyuki
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322; 1524-4539

IntroductionSleeve procedure, in which Valsalva graft is used to externally cover the entire aortic root, is a simplified approach compared to David or Yacoub procedure in repairing aortic root. To increase the commissure height is important in aortic valve repair to increase the leaflet coaptation surface. Diameters of annulus, sinus of Valsalva (SoV) and sino- tubular junction (STJ) can be reduced by Sleeve procedure, however, its effect on the commissure height is unknown.HypothesisWe hypothesized that Sleeve technique increases commissure height.MethodsTotally 17 patients with severe aortic regurgitation with mild to moderate aortic root dilatation who underwent aortic repair with Sleeve procedure were studied. In the Sleeve procedure, STJ cut end was sutured with slightly lifting the commissures up and letting the sinuses down to peripheral end of the Valsalva graft. Then the aortic root sheathed with Valsalva graft was connected to proximal end of ascending aorta. Each commissure height was measured as the distance between the commissure and annular plane with 3D CT volume dataset using dedicated software (syngo.via, Siemens) and then average of each commissure height (CH) was calculated.ResultsCH was increased from 16.6±3.4 to 18.9±2.6 mm by Sleeve procedure. VR image visually proved the increased CH, showing pre-operative obtuse inter-leaflet triangle and post-operative acute inter-leaflet triangle (Figure).ConclusionsSleeve technique increased the commissure height, which presumably resulted from the ingenuity in suturing STJ cut end, and also from the longitudinal stretch of SoV caused by radial shortening because of the sheath of Valsalva graft. Sleeve procedure can possibly be an alternative to David procedure in repairing aortic valve for patients with mild to moderate aortic root dilatation.