Aortic Valve Repair in Annular Dilatation: External vs Internal Suture Annuloplasty

BACKGROUND: Annuloplasty is essential in aortic valve repair. The most appropriate technique is highly controversial, however. We aimed to evaluate changes in postoperative annulus diameter on serial echocardiography after external and internal suture annuloplasty.

METHODS: We retrospectively reviewed serial transthoracic echocardiography of consecutive patients from our institutional aortic valve repair registry who had received suture annuloplasty. Midsystolic annulus diameter was measured on parasternal long-axis view preoperatively, at discharge, 3-6 months, and at 1, 2 and 3 years postoperatively. Primary endpoint was the prevalence of annulus redilatation. Secondary endpoints were the correlation between annulus redilatation and (1) external vs internal technique and (2) reoccurrence of aortic insufficiency ≥2.

RESULTS: A total of 70 patients (mean ± SD age: 43 ± 13 years, 91% male) underwent aortic valve repair including external (n = 27) or internal (n = 43) suture annuloplasty between February 2016 and November 2019. Mean follow-up was 17 ± 11 (range: 3-50) months. Mean preoperative annulus diameter of 29.7 ± 2.8 (23.8-37.8) mm was significantly reduced to 22.7 ± 2.9 (16.7-31.7) mm, P < .001 at discharge and increased to 23.8 ± 2.3 (20.9-27.0) mm, P = .037 during follow-up. The mild increase in postoperative annulus diameter did not correlate with the reoccurrence of aortic insufficiency ≥2. Preoperative annulus was significantly larger in the external group (external: 30.6 ± 3.2 mm; internal: 29.1 ± 2.5 mm; P = .032). However, we found no significant difference in postoperative annulus increase rate between both techniques.

CONCLUSIONS: Although mild, a significant continuous increase of annulus diameter after suture annuloplasty was seen, which did not correlate with the reoccurrence of aortic insufficiency ≥2 at mid-term follow-up. Annulus redilatation was comparable between external and internal technique.