Mid-term outcomes after aortic valve repair with the internal geometric annuloplasty ring

BACKGROUND: The internal geometric annuloplasty ring is the only commercially available aortic annuloplasty ring designed to reduce and prevent annular dilatation during aortic valve repair; however, data regarding its long-term durability remain limited. Here we present our mid-term outcomes. METHODS: A retrospective review was conducted of all adult patients who underwent aortic valve repair using the internal geometric annuloplasty ring between January 2017 and May 2025. Patients requiring valve reintervention were included in the analysis. RESULTS: Eighteen aortic valve repairs were performed in 17 patients (mean age, 54 ± 15 years; 16 males; 14 tricuspid valves, 2 bicuspid valves, 1 unicuspid valve), including 1 redo repair. Ten cases (56%) involved concomitant aortic root remodeling. Tricuspid 21-mm rings were used most frequently (61%). During a mean follow-up of 3.7 ± 1.7 years, 8 reinterventions were required in 7 patients (44%) owing to severe aortic insufficiency (AI; n = 7) or endocarditis with moderate AI (n = 1). The 5-year estimated reintervention rate was 40.8% (95% confidence interval, 20.0%-70.5%). Reinterventions included surgical aortic valve replacement (n = 5), redo internal geometric annuloplasty (n = 1), aortic root replacement (n = 1), and valve-in-ring transcatheter aortic valve replacement (n = 1). In surgical cases, postexplantation annular dimensions of the ring consistently returned to their preimplantation sizes. CONCLUSIONS: In our experience, 44% of patients receiving the internal geometric annuloplasty ring required aortic valve reintervention. Although effective in reducing annular size, the ring's rigid intra-annular design and the potential for excessive annular downsizing may predispose to recurrent insufficiency and limit future transcatheter options, prompting careful consideration of its broad application.