Mid-term outcomes of aortic valve repair using an anatomically shaped internal annuloplasty ring.

The Hemispherical Aortic Annuloplasty Reconstructive Technology (HAART) ring is a rigid, internal, and geometric device. The objective of this paper is to assess the mid-term outcomes of aortic valve repair using this prosthesis. A prospectively maintained database was used to obtain outcomes for adult patients undergoing aortic valve repair using the HAART ring between September 2017 and June 2023. All aortic patients at our institution undergo life-long surveillance with regular assessment and valve imaging. 71 patients underwent aortic valve repair using the HAART device: 53 had a trileaflet valve and 18 a bicuspid valve. The median age was 54 years, and most were male (79%). Many required concomitant intervention: 46% had a root procedure, and 77% an arch repair. There were no in-hospital deaths, and the median post-operative stay was 5 days. At a mean follow up of 3.9 (±1.1) years, freedom from re-operation was 94%. Late imaging demonstrated: zero-trace(25%), 1 + (54%), 2 + (15%), and 4 + (6%) aortic insufficiency (AI). Eleven patients have ≥moderate AI under surveillance, all of whom have a trileaflet valve (21% of trileaflet patients). Four patients required re-operation: three for ring dehiscence and one for endocarditis. Although early results using the HAART device are encouraging, mid-term results raise concern as 21% of trileaflet patients developed recurrent ≥moderate AI by 4 years post-repair. We experienced three incidences of ring dehiscence requiring re-operation. Based on this, we recommend caution using the subannular approach for stabilisation in patients with trileaflet aortic valves. Long-term results are needed to assess outcomes against established techniques.

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.