Key result
Double ring annuloplasty is linked to ~88% lower 6-year valve reintervention risk versus single ring.
Why the study?
Aortic valve insufficiency with a normal root and ascending aorta is often treated with valve replacement, which carries prosthetic complications; outcomes of standardized isolated repair using single versus double ring annuloplasty required comparison.
Does double ring annuloplasty reduce valve-related reintervention and recurrent aortic insufficiency compared to single ring annuloplasty in patients with isolated aortic insufficiency?
Cohort (n=93)
No
Does double ring annuloplasty reduce valve-related reintervention and recurrent aortic insufficiency compared to single ring annuloplasty in patients with isolated aortic insufficiency?
Absolute Event Rate: 3% vs 26%
p-value: p=0.02
Adding a supravalvular ring at the sinotubular junction to subvalvular ring annuloplasty significantly improves valve durability and reduces reintervention in patients with isolated aortic insufficiency.
May support double ring annuloplasty for durability in isolated AI; extends single-ring data but leaves open need for RCTs.
OBJECTIVES: Aortic valve (AV) insufficiency with normal root and ascending aorta is most frequently treated by valve replacement with significant prosthetic-related complications and reduced life expectancy. We compared the outcomes of a new standardized isolated AV repair approach using an external aortic annuloplasty ring at the subvalvular level (single ring annuloplasty) and the role of an additional supravalvular ring at the sinotubular junction (double ring annuloplasty). METHODS: Single centre data were collected from the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) between 2003 and 2017. A total of 93 patients (56 single ring and 37 double ring) underwent isolated AV repair. RESULTS: The overall 30-day mortality rate and the need for a permanent pacemaker were 1% and 2%, respectively. The overall survival rate at 6 years was similar for sex- and age-matched members of the general population (89% vs 95%; P = 0.1) and did not differ between the double and single ring groups (82% vs 93%; P = 0.4) at 6 years. There were no thromboembolic or bleeding events in the entire cohort. However, at 6 years, the cumulative incidence of valve-related reintervention was 26% in the single ring annuloplasty group compared to 3% in the double ring annuloplasty (P = 0.02) group. Similarly, at 6 years, the cumulative incidence of moderate-to-severe (>2) aortic insufficiency was 30% in the single ring annuloplasty group compared to 0% in the double ring annuloplasty group (P = 0.007). CONCLUSIONS: Standardized AV repair with external ring annuloplasty has a survival rate similar to that of the general population. The additional stabilization of the sinotubular junction with a second supravalvular ring (double ring annuloplasty) is associated with better outcomes compared to single subvalvular annuloplasty. It can be considered as a first line intervention for patients with isolated aortic insufficiency and pliable leaflets.
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Zakkar et al. (2019) conducted a cohort in Isolated aortic insufficiency (n=93). Double ring annuloplasty vs. Single ring annuloplasty was evaluated on Cumulative incidence of valve-related reintervention at 6 years (p=0.02). Double ring annuloplasty reduced 6-year valve-related reintervention (3% vs 26%, P=0.02) and moderate-to-severe aortic insufficiency (0% vs 30%, P=0.007) compared to single ring annuloplasty.
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