• Lauren Basmadjian, Arsène J Basmadjian, Louis-Mathieu Stevens, François-Pierre Mongeon, Raymond Cartier, Nancy Poirier, and Ismail El Hamamsy.
• Division of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada.
• J. Thorac. Cardiovasc. Surg. 2016 May 1; 151 (5): 1280-5.e1.

ObjectivesDilatation of the aortic annulus is a cause of recurrent aortic regurgitation following the Ross or Yacoub procedures. Use of an extra-aortic annuloplasty ring is a potentially useful adjunct procedure. The aim of this study was to analyze the early effectiveness and mid-term stability of this surgical approach.MethodsFrom 2011 to 2015, 50 patients (mean age, 43 ± 14 years) underwent adjunct extra-aortic annuloplasty ring implantation (n = 39 Dacron rings and n = 11 ExAo rings [CORONEO Inc, Montreal, Canada]). Median ring size was 28 mm (range, 27-32 mm). All patients had aortic regurgitation or a dilated aortic annulus. Concomitant surgical procedure was a valve-sparing remodeling procedure (n = 32) or a Ross procedure (n = 18). Baseline and follow-up echocardiographic systolic and diastolic aortic annular dimensions were prospectively collected. Longitudinal analyses were performed using mixed-effect models. Median follow-up was 12 months (98% complete).ResultsUse of an extra-aortic annuloplasty ring resulted in a significant decrease in both systolic (27.9 ± 0.5 mm preoperatively vs 23.6 ± 0.3 mm at discharge, P < .001) and diastolic (24.8 ± 0.4 mm preoperatively vs 20.3 ± 0.3 mm at discharge, P < .001) dimensions. Mean systolic and diastolic dimensions remained statistically unchanged up to 2 years postoperatively, compared with their predischarge values. Systolic expansion of the annulus was conserved early after surgery (16% systolic expansion) and preserved up to 2 years after ring implantation.ConclusionsUse of an extra-aortic annuloplasty ring is effective at reducing annular diameters. This remains stable at mid-term follow-up, with preservation of aortic annular dynamics. Longer-term studies are required to determine the continued stability and impact on long-term clinical outcomes.Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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