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Aortic Valve Repair Using HAART 300 Geometric Annuloplasty Ring: A Review and Echocardiographic Case Series

Published:March 19, 2022DOI:https://doi.org/10.1053/j.jvca.2022.03.013
      Aortic valve repair (AVr) aims to preserve the native aortic leaflets and restore normal valve function. In doing so, AVr is a more technically challenging approach than traditional aortic valve replacement. Some of the complexity of repair techniques can be attributed to the unique structure of the functional aortic annulus (FAA), which, unlike the well-defined mitral annulus, is comprised of virtual and functional components. Though stabilizing the ventriculo-aortic junction (VAJ), a component of the FAA, is considered beneficial for patients with chronic aortic insufficiency (AI), the ideal AVr technique remains a subject of much debate. The existing AVr techniques do not completely stabilize the VAJ which may increase susceptibility to recurrent AI due to VAJ dilation. An emerging new technique showing promise for the treatment of both isolated and complex AI is AVr using HAART 300TM geometric annuloplasty ring (GAR). The GAR is implanted below the valve leaflets in the left ventricular outflow tract (LVOT), providing stability and creating a neo-annulus. As with other AVr subtypes, this procedure has a learning curve. There are unique surgical and echocardiographic aspects of AVr with GAR, including the appearance of the LVOT, the aortic valve leaflets, and their motion which cardiac anesthesiologists and echocardiographers must be familiar with. In this work, using an eight-patient echocardiographic case series, we provide an overview of this novel AVr technique, including some unique aspects of device sizing, patient selection, expected post-repair echocardiographic features, and a review of outcomes data.

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      References

        • Rankin JS
        • Mazzitelli D
        • Fischlein TJM
        • et al.
        Bicuspid aortic valve repair using geometric ring annuloplasty: A first-in-humans pilot trial.
        JTCVS Tech. 2020; 1: 18-25
        • Rankin JS
        • Mazzitelli D
        • Fischlein T
        • et al.
        Geometric ring annuloplasty for aortic valve repair during aortic aneurysm surgery: Two-year clinical trial results.
        Innovations (Phila). 2018; 13: 248-253
        • Mazzitelli D
        • Fischlein T
        • Rankin JS
        • et al.
        Geometric ring annuloplasty as an adjunct to aortic valve repair: Clinical investigation of the HAART 300 device.
        Eur J Cardiothorac Surg. 2016; 49: 987-993
        • Mazzitelli D
        • Nöbauer C
        • Rankin JS
        • et al.
        Early results of a novel technique for ring-reinforced aortic valve and root restoration†.
        Eur J Cardiothorac Surg. 2014; 45: 426-430
        • Papakonstantinou NA
        • Kogerakis N
        • Kantidakis G
        • et al.
        A modern approach to aortic valve insufficiency: Aortic root restoration via HAART 300 internal annuloplasty ring.
        J Card Surg. 2021; 36: 4189-4195
        • Gocoł R
        • Jasiński M
        • Hudziak D
        • et al.
        Surgical correction of aortic regurgitation using a HAART 300 rigid aortic ring: A novel method to standardize aortic valve repair.
        Cardiol J. 2019; 26: 799-801
        • Juściński JH
        • Koprowski A
        • Kołaczkowska M
        • et al.
        First uses of HAART 300 rings for aortic valve repair in Poland—4 case studies.
        Kardiochir Torakochirurgia Pol. 2018; 15: 38-43
        • Jawitz OK
        • Raman V
        • Anand J
        • et al.
        Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: Early results from a single-centre experience.
        Eur J Cardiothorac Surg. 2020; 57: 1137-1144
        • Bisleri G.
        Aortic valve repair.
        Curr Opin Cardiol. 2016; 31: 581-584
        • Antoniou A
        • Harky A
        • Bashir M
        • et al.
        Why I choose to repair and not to replace the aortic valve?.
        Gen Thorac Cardiovasc Surg. 2019; 67: 20-24
        • Berrebi A
        • Monin JL
        • Lansac E.
        Systematic echocardiographic assessment of aortic regurgitation-what should the surgeon know for aortic valve repair?.
        Ann Cardiothorac Surg. 2019; 8: 331-341
        • Rankin JS
        • Beavan LA
        • Cohn WE.
        Technique for aortic valve annuloplasty using an intra-annular "hemispherical" frame.
        J Thorac Cardiovasc Surg. 2011; 142: 933-936
        • Mazzitelli D
        • Nöbauer C
        • Rankin JS
        • et al.
        Early results after implantation of a new geometric annuloplasty ring for aortic valve repair.
        Ann Thorac Surg. 2013; 95: 94-97
        • Khelil N
        • Sleilaty G
        • Palladino M
        • et al.
        Surgical anatomy of the aortic annulus: Landmarks for external annuloplasty in aortic valve repair.
        Ann Thorac Surg. 2015; 99: 1220-1226
        • de Kerchove L
        • El Khoury G.
        Anatomy and pathophysiology of the ventriculo-aortic junction: Implication in aortic valve repair surgery.
        Ann Cardiothorac Surg. 2013; 2: 57-64
        • El Khoury G
        • Glineur D
        • Rubay J
        • et al.
        Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures.
        Curr Opin Cardiol. 2005; 20: 115-121
        • Youssefi P
        • El-Hamamsy I
        • Lansac E.
        Rationale for aortic annuloplasty to standardise aortic valve repair.
        Ann Cardiothorac Surg. 2019; 8: 322-330
        • Federspiel JM
        • Ehrlich T
        • Abeln K
        • et al.
        Aortic annuloplasty: Subcommissural, intra-annular suture techniques, external and internal rings.
        JTCVS Tech. 2021; 7: 98-102
        • Kunihara T.
        Toward standardization of valve-sparing root replacement and annuloplasty.
        Gen Thorac Cardiovasc Surg. 2018; 66: 685-691
        • Rankin JS.
        An intra-annular 'hemispherical' annuloplasty frame for aortic valve repair.
        J Heart Valve Dis. 2010; 19: 97-103
        • Rankin JS
        • Bone MC
        • Fries PM
        • et al.
        A refined hemispheric model of normal human aortic valve and root geometry.
        J Thorac Cardiovasc Surg. 2013; 146 (e101): 103-108
        • Lansac E
        • Di Centa I
        • Sleilaty G
        • et al.
        Long-term results of external aortic ring annuloplasty for aortic valve repair.
        Eur J Cardiothorac Surg. 2016; 50: 350-360
        • Parolari A
        • Barili F
        • Pilozzi A
        • et al.
        Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis review.
        Ann Thorac Surg. 2014; 98: 2255-2263
        • Rankin JS
        • Wei LM
        • Downey RS
        • et al.
        Aortic valve repair using geometric ring annuloplasty.
        Op Tech Thoracic Cardiovasc Surg. 2021; 26: 173-188
      1. BioStable Science & Engineering. Instructions for Use—HAART 300 Aortic Annuloplasty Device. Available at: https://biostable-s-e.com/ifu-details/?lang_id=4&parent_ifu_id=7&ifu_id=4. April 26, 2022

        • Bothe W
        • Miller DC
        • Doenst T.
        Sizing for mitral annuloplasty: Where does science stop and voodoo begin?.
        Ann Thorac Surg. 2013; 95: 1475-1483
        • Carpentier A
        • Adams D
        • Filsoufi F.
        Carpentier's reconstructive valve surgery.
        1st ed. Saunders, Philadelphia, PA2010
      2. BioStable Science & Engineering. HAART physician locator. Available at: https://biostable-s-e.com/haart-physician-locator/. Accessed January 31, 2022.

        • Van Dyck MJ
        • Watremez C
        • Boodhwani M
        • et al.
        Transesophageal echocardiographic evaluation during aortic valve repair surgery.
        Anesth Analg. 2010; 111: 59-70
        • Augoustides JG
        • Szeto WY
        • Bavaria JE.
        Advances in aortic valve repair: Focus on functional approach, clinical outcomes, and central role of echocardiography.
        J Cardiothorac Vasc Anesth. 2010; 24: 1016-1020
        • David TE
        • David CM
        • Tsang W
        • et al.
        Long-term results of mitral valve repair for regurgitation due to leaflet prolapse.
        J Am Coll Cardiol. 2019; 74: 1044-1053
        • le Polain de Waroux JB
        • Pouleur AC
        • Goffinet C
        • et al.
        Functional anatomy of aortic regurgitation: Accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography.
        Circulation. 2007; 116: I264-I269
        • le Polain de Waroux JB
        • Pouleur AC
        • Robert A
        • et al.
        Mechanisms of recurrent aortic regurgitation after aortic valve repair: Predictive value of intraoperative transesophageal echocardiography.
        JACC Cardiovasc Imaging. 2009; 2: 931-939
        • Dvir D.
        Aortic valve-in-valve hemodynamics.
        Cardiac Interv Today. 2018; 12: 7-9
        • Sun L
        • Rajamannan NM
        • Sucosky P.
        Defining the role of fluid shear stress in the expression of early signaling markers for calcific aortic valve disease.
        PLoS One. 2013; 8: e84433
        • Barker CM
        • Wyler von Ballmoos M
        • Reardon MJ.
        Are TAVR hemodynamics important in the lower-risk population?.
        Cardiac Interv Today. 2018; 12: 3-6
        • Pettersson GB
        • Crucean AC
        • Savage R
        • et al.
        Toward predictable repair of regurgitant aortic valves: A systematic morphology-directed approach to bicommissural repair.
        J Am Coll Cardiol. 2008; 52: 40-49
        • Ridley C
        • Sohmer B
        • Vallabhajosyula P
        • et al.
        Aortic leaflet billowing as a risk factor for repair failure after aortic valve repair.
        J Cardiothorac Vasc Anesth. 2017; 31: 1001-1006
        • Yanagawa B
        • Mazine A
        El-Hamamsy I. Predictors of aortic valve repair failure.
        Innovations (Phila). 2019; 14: 199-208
        • Scharfschwerdt M
        • Pawlik M
        • Sievers H-H
        • et al.
        In vitro investigation of aortic valve annuloplasty using prosthetic ring devices.
        Eur J Cardiothoracic Surg. 2011; 40: 1127-1130
        • Mazzitelli D
        • Stamm C
        • Rankin JS
        • et al.
        Hemodynamic outcomes of geometric ring annuloplasty for aortic valve repair: A 4-center pilot trial.
        J Thorac Cardiovasc Surg. 2014; 148: 168-175
        • Parnell A
        • Swanevelder J.
        High transvalvular pressure gradients on intraoperative transesophageal echocardiography after aortic valve replacement: What does it mean?.
        HSR Proc Intensive Care Cardiovasc Anesth. 2009; 1: 7-18
        • Baker JN
        • Klokocovnik T
        • Miceli A
        • et al.
        Minimally invasive aortic valve repair using geometric ring annuloplasty.
        J Card Surg. 2022; 37: 70-75
      3. Rankin JS. HAART annuloplasty device valve repair registry. Available at: https://www.clinicaltrials.gov/ct2/show/study/NCT04035356. Accessed December 21, 2021.

        • Mauri V
        • Reimann A
        • Stern D
        • et al.
        Predictors of permanent pacemaker implantation after transcatheter aortic valve replacement with the SAPIEN 3.
        JACC Cardiovasc Interv. 2016; 9: 2200-2209
        • Takayuki G
        • Volker H
        • Axel H
        • et al.
        Transfemoral transcatheter aortic valve implantation after aortic valve repair with HAART 300 device.
        Catheter Cardiovasc Interv. 2019; 94: 856-858
        • Vogt F
        • Marianowicz J
        • Jessl J
        • et al.
        Balloon transcatheter aortic valve replacement after aortic valve repair with HAART 300 device.
        Ann Thorac Surg. 2020; 110: e375-e376
        • Ozgol I
        • Depboylu BC
        • Tongut A
        • et al.
        Evaluation of infection resistance of biodegradable versus conventional annuloplasty rings in an in vivo rat subcutaneous model.
        Eur Surg Res. 2017; 58: 169-179

      Linked Article

      • Aortic Valve Repair: The Evolving Frontiers of Aortic Annuloplasty
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 11
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          THE TECHNIQUES in aortic valve repair have matured for the management of aortic insufficiency, with or without associated aortic pathology, to offer patients freedom from the complications of prosthetic valves, including thromboembolism, endocarditis, anticoagulant-related hemorrhage, and reoperation due to structural valve deterioration.1-3 This steady evolution has been enhanced by advances, including a repair-oriented classification system, annular stabilization, the standardization of leaflet repair techniques, and a systematic assessment with echocardiography.
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