Abstract 11886: Total Root Remodeling by Sleeve Technique for Severe Aortic Regurgitation in Patient With Mild or Moderate Root Dilatation

Abstract

Introduction: Cusp repair in combination with root repair is a central strategy for aortic regurgitation (AR). However, aortic root replacement in patient without significant root dilatation is controversial. Hypothesis: Sleeve procedure can be an alternative to root replacement in such clinical settings. Methods: 27 tricuspid aortic valve patients (Body surface area: 1.64±0.16 m2) without significant root dilatation who underwent aortic valve repair with Sleeve procedure during January, 2017-April 2020 were studied. Of the 81 cusps, 34 cusps underwent central plication. Neo-chord technique was prophylactically applied in 12 cusps to prevent future leaflet prolapse. Selected Valsalva graft size was 26.1±1.4 mm. Pre- and post-operative diastolic valve geometry was evaluated by 3D cardiac computed tomography. Results: Geometric change in aortic valve by Sleeve is summarized in the Table. Postoperative increase in commissure height was noted and effective height of non-plicated cusp kept more than 8.5 mm in average postoperatively despite of the nearly 10 mm reduction in STJ diameter. There was no recurrence of AR more than grade II in one year follow-up. Conclusions: Preserved or increased commissure height by Sleeve procedure may contribute to sufficient cusp coaptation with preventing an iatrogenic cusp prolapse. Because of the external covering with the graft, neo-chord technique could be stably performed under Sleeve procedure. Sleeve procedure offers valve-sparing and total root remodeling without root replacement/coronary reconstruction in repairing AR, which may be beneficial for patients with mild or moderate root dilatation.