Feasibility and durability of annular stabilization using an internal fixation ring in aortic valve repair: a computed tomography-based study.

Abstract

Objectives: Aortic annulus dilatation is a critical risk factor for late aortic insufficiency (AI) recurrence after isolated aortic valve repair. Durable annular stabilization remains technically challenging, and long-term data are limited. We evaluated the mid-term geometric stability of a novel "internal annular fixation ring" technique using an expanded polytetrafluoroethylene (ePTFE) ring and metallic holder.

Methods: We retrospectively analyzed 27 consecutive patients who underwent isolated aortic valve repair with internal annular fixation ring technique for significant AI between January 2015 and April 2024. Aortic root geometry was assessed using cardiac computed tomography (CT) and transthoracic echocardiography, preoperatively and during follow-up. The mean follow-up period for CT was 49.0 ± 38.2 months. The primary outcome was aortic annular stability assessed by agreement between the intended intraoperative annular diameter and the average annular diameter or area-derived annular diameter measured on follow-up CT. Secondary outcomes included freedom from aortic valve reintervention, echocardiographic and CT findings, late survival, and freedom from moderate AI.

Results: Overall, concomitant leaflet repair was performed in 74.1% of patients. The intended intraoperative annular diameter ((22 mm (22-24)) was not significantly different from the average annular diameter (22.2 mm (21.4-23.4), p = 0.49) or the area-derived annular diameter (22.2 mm (21.0-23.3), p = 0.15) measured on the follow up CT. Freedom from aortic valve reintervention was 92.3% at 7 years. Although no severe AI recurred, moderate AI developed in 7 patients (25.9%); however, no patient required hospitalization for heart failure during follow-up period.

Conclusions: The internal annular fixation ring technique provides feasible and durable aortic annulus stabilization in isolated aortic valve repair. Moderate AI recurrence highlights the need for further technical refinements.