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Aortic Valve Anuluplasty System

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

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Aortic Valve Anuluplasty System

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  1. Aortic Valve Anuluplasty System Designedby KhalilFattouch, MD, PhD.

  2. Aortic valve Whatwelearnfrom the mitral valve? Surgeons are notconcernedabout the valve, butwith the AorticFunctionalUnit • Aortic anulus • Cusps • Valsalva sinus • Commissures • Sinotubular Junction • Ascending aorta

  3. RelationshipbetweenseveralsAorticRootComponents are importantfornormal valve function AA > STJ (10-15%) Coaptation high = 0.5-0.8 cm High ofopenedleaflet = 70% ofsinus

  4. Tipo Ia- STJ Dilation

  5. FunctionalClassificationof AR • Ia – STJ dilation • Ib – dilationofvalsalvasinuses • Ic – FAA dilation • Id – Perforation Tipo I: Normal leaflet motion Tipo II: Excessive leaflets motion • Prolapse • Dissection Tipo III: Restrictiveleafletsmotion • Calcification • Cuspfusion

  6. Lessonfrommitral valve repair • Anuluplastyis a fundamentalstep in mitral valve repair: • re-shape the anulus • stabilize the repair • improve long termresults

  7. AorticAnulus What is the true valve anulus?

  8. Aortic Anulus Commissures Nadir

  9. FunctionalAorticAnulus Sinutubular ridge commissures FAA = (Anatomicalanulus + STJ) Basal circumference Interleaflet triangles

  10. Ring foraortic valve repairmust:1. re-shape the functionalaorticanulus2. Stabilize the continuitybetween the aortic valve annulus and the STJ.

  11. The secondpointofviewInterleafletsTriangles Are essentialsfornormalleaflets opening and normaldistribuitionof stress Annulus

  12. Mechanism of Opening:sequence of leaflets opening Stellate orifice Small triangle Triangle Circular orifice

  13. 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”

  14. The secondobjective? The ring foraortic valve repairmust, Leave the commissures and the interleafletstriangle free tomove during the cardiaccicle, thatisessential for a normalleafletsmotion and stress distribuition

  15. Today, whatwe do in aortic valve repair? Subcommissuresplasty

  16. Our idea, tore-shape the functionalaorticanulus and preserveaorticleafletsmotion Re-shape the STJ Re-shape the anatomicalanulus

  17. From inside LV outflowtract Fromoutside the aorta

  18. Suture Technique Leave free the interleafletstriangles a b

  19. Re-shape the sinotubularjunction Appliedoutsideto the aorta at the levelof the STJ and suturedto the aorta with the same suture linewhenweclose the aortotomyusing 4-0 prolene. The 3 crown weresutured at the levelofcommissures and fixed to the internal ring using the same ticronU-stitchusedpreviously.

  20. The D shapeof the annulusavoidblood turbolence under the aortic valve Flexible zone Free from suture

  21. Suture Technique

  22. Objective • Re-shape and Stabilize the functionalaorticannulus • Undersize the anatomicalaorticannulusfrom inside of • LV outflowtract (improveleafletscoaptation). • Leave the interleafletstriangles and commissures free to • movethatismandatoryfor a normalleaflets stress • distribuition and motion (opening). • An externalapplicationof a ring mayleadtocuspsprolapse. • Thankfor……

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