Key result
Proposed lesional classification for chronic AI uses central or eccentric jets to standardize surgical repair.
Why the study?
Aortic valve repair for chronic aortic insufficiency lacks a standardized surgical management approach based on lesion classification.
Observational (n=781)
A proposed lesional classification based on echocardiographic and operative findings provides a standardized framework for selecting specific surgical techniques in aortic valve repair.
Answers are grounded in this paper and cite their sources.
Proposed classification may aid standardization of aortic valve repair; leaves open prospective validation before clinical adoption.
OBJECTIVE: Aortic valve repair is an alternative to valve replacement for treatment of chronic aortic insufficiency (AI). In order to standardize surgical management, we suggest a classification based on echocardiographic and operative analysis of valvular lesions. METHODS: Classification was based on the retrospective analysis of chronic AI mechanisms of 781 adults operated on electively between 1997 and 2003. RESULTS: AI was isolated (406 patients (52%)), associated with supra-coronary aneurysm (97 cases (12.4%)), or with aortic root aneurysm (278 patients (35.6%)). Etiologies of valvular or aortic lesions were respectively rheumatic, dystrophic and atheromatous in 17%, 73.6% and 9.4% of cases. Lesional classification is based on the analysis of chronic AI mechanisms defining type I with central jet (354 cases, 45.3%) and type II with eccentric jet (54.7%). Type Ia is defined as isolated dilation of sino-tubular junction (47 supra-coronary aneurysms), and type Ib as dilation of both sino-tubular junction and aortic annular base (233 root aneurysms, 74 isolated AI). The type II associates dilation of sino-tubular junction and annular base to a valvular lesion: IIa cusp prolapse (95 aneurysms, 200 isolated AI); IIb cusp retraction (132 rheumatic AI), IIc cusp tear (endocarditis, traumatic). CONCLUSION: A lesional classification aims to standardize the surgical management of aortic valve repair: type Ia, by supra-coronary graft; type Ib, by subvalvular aortic annuloplasty associated with the aortic root replacement with a remodelling technique (root aneurysm) or double sub- and supravalvular annuloplasty (isolated AI). For chronic AI type II, aortic annuloplasty associated a remodelling technique or double sub- and supravalvular annuloplasty is combined with the treatment of the cusp lesion (cusp resuspension, cusp reconstruction with autologous pericardium).
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Lansac et al. (2008) conducted an observational in Chronic aortic insufficiency (n=781). Lesional classification of chronic AI mechanisms was evaluated on Classification of chronic AI mechanisms. A retrospective analysis of 781 adults with chronic aortic insufficiency proposed a lesional classification based on central (45.3%) or eccentric (54.7%) jets to standardize surgical valve repair.
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