A new guiding strategy for treating the free margin of the leaflet in an aortic root remodelling procedure.

Backgroud: In valve-sparing aortic root replacement procedure, leaflet prolapse can be corrected by shortening the length of the free margin. But precisely determining the extent of the reduction remains a problem. This study wants to explore the effectiveness of a guiding strategy in treating the free margin of the leaflet in a modified aortic root remodelling procedure with external sub-valvular ring.

Methods: Between January 2021 and May 2024, 12 patients with aortic root aneurysms underwent modified aortic root remodelling with an external sub-valvular ring (10 males and two females). Their mean age was 42 ± 14 years. The graft diameter was determined according to the criteria of the Lansac group, based on the aortic annulus diameter. The free margin of the leaflet was treated with central plication based on a standard (target length of the free margin of the leaflet = the diameter of the selected graft + 3 ~ 5 mm).

Results: The surgery was successfully completed in all 12 patients, with no hospital deaths or complications. Four patients required central plication of the free margin of three leaflets, two required treatment of two leaflets, three required treatment of one leaflet, and three did not require treatment of the free margin of the leaflet. No more than mild degree of residual aortic regurgitation was observed postoperatively. After reconstruction of the aortic root, the measured effective height and coaptation length were 8.9 ± 1.3 mm and 5.3 ± 0.9 mm, respectively.

Conclusions: A guiding strategy based on the diameter of the selected graft can be effectively used to manage the length of the free margin of the leaflet in a modified aortic root remodelling procedure with external sub-valvular ring.