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Bicuspid Aortic Valve Repair by Implantation of External Dacron Ring and Cusp Plication

Monday, March 16, 2015

A 49-year-old male patient underwent cardiac surgery for massive regurgitation of a bicuspid aortic valve in an anteroposterior configuration. A conservative approach was chosen. The ventricular-aortic junction was reduced with an external dacron ring, and the anterior cusp was plicated to re-establish optimal coaptation. No residual regurgitation was present at the end of the operation.


I would like to commend the authors for the demonstration of a good reproducible technique. But I have a few doubts which I hope would be cleared. 1. What is the advantage of using a Dacron ring rather than a PTFE suture annuloplasty?? 2. How much downsizing is done when choosing the Dacron ring and is it chosen only based on the Hegar size? 3. If there is a concomitant ascending aortic replacement would the size of the Dacron ring vary with the graft size or the annulus size
"Ventriculo-Aortic Junction size can be predicted by application of continuity rules". Thanks for sharing your own method of VAJ stabilization; to each presented technique is something being caught on . Concerning the so-called annulus size, I consider the ideal VAJ size as the diameter of aortic isthmus (in the abscence of aortic disease) plus 2mm in the case of bicuspidia (as the VAJ size in the case of normally functionning bicuspid valve is greater than tricuspid confuguration). Otherwise I would rather tyeing sutures over hegar bougie as to ensuring harmonious VTJ stabilization. I think we should not apply the requiered dacron size for ascending aorta to influence the choice of VAJ stabilisation size nor inversa, rather we should consider a two stage repairing: aortic root & ascending aorta mandate tailored segmental approach. Regards
If the ring was to be transected ONLY ONCE, would not be possible to insert it underneath the coronaries and save the (cross-clamp and bypass) time to suture a SECOND cut? Useful technique, many thanks.

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