Background: Aortic valve insufficiency (AI) at the time of left ventricular assist device (LVAD) insertion needs to be corrected, however there is little known about how to manage bioprosthetic valvular AI. Case presentation: A 55-year-old female with dilated cardiomyopathy who previously had a bioprosthetic aortic valve replacement needed a LVAD as a bridge to transplant. Her left ventricular ejection fraction was 10% and had mild to moderate transvalvular AI. She underwent a HeartWare HVAD insertion along with aortic valvular coaptation stitch repair (Park's stitch) to the bioprosthetic valve. Conclusion: Her AI improved to trivial with minimal ejection through the bioprosthetic valve. She was transplanted 6 months following the surgery. A Park's stitch to the bioprosthetic aortic valve with more than mild AI might be a good option for bridge to transplant patient.

The ability to accurately and in a repeatable fashion, measure aortic valve dimensions during aortic valve repair is critical to the restoration of function in a diseased aortic valve, as for example in aortic insufficiency. Although several methods for measuring aortic valve dimensions have been shown to be feasible, they are approximate and lack the accuracy, robustness, and repeatability one would expect to support aortic valve repair surgery. In addition, they do not allow for the intra-operative measurement of aortic valves under conditions equivalent to the physiological (pressurized) state. A prototype medical device was designed, and 3-D printed at the University of Ottawa that would allow cardiac surgeons performing aortic valve repair to do just that. The prototype was tested for its accuracy and precision at the University of Ottawa Heart Institute using porcine aortic valves. Based on unsatisfactory results of this experimentation, namely, that the device was applying forces that were too large, a numerical simulation study was designed using a commercial finite element software LS-DYNA. This simulation study was used to explore the forces that the prototype device needed to apply to obtain end-diastolic pressurized dimensions of the aortic valve. The simulation study showed that one single device was likely not possible to obtain measurements in an aortic valve. However, a system of two devices could be imagined, one to measure the STJ diameter and free margin length of the aortic valve cusps, and one to measure the cusp height of the same valve, for the purposes of aortic valve repair.

IntroductionThe young adult patients with aortic valve insufficiency undergo aortic valve replacement (AVR) and are forced to take anticoagulation medications for the rest of life due to prosthetic valve. This leads to many post-operative complications and drastic outcomes. Whereas, the in-vogue alternative of aortic valve repair (AVr) is available and a lot more beneficial as well.Especially considering the surgeon’s skills for selected repair procedure, selectively chosen patient with mild to moderate grades of aortic valve insufficiency and no significant comorbidities present for at least five (5) years or longer time. AimThe aim of this study was to affirm ‘if all kind of outcomes of aortic valve repair are beneficial alternative to aortic valve replacement (AVR) for the patients suffering from aortic valve insufficiency for at least five (5) years or longer time. Material and MethodsInternet search using standard key words of ‘Aortic Valve Repair and Outcomes’ was used to find both white literature (officially published literature) and grey literature (unpublished or ongoing study/literature) with human, adult, English language and studies published after January 1st 2007 as limitations. Inclusion criteria was adult patients with aortic insufficiency with aortic valve repair as intervention with outcomes at least greater than five (5) years were considered. All the data was extracted using Microsoft excel for windows and was analyzed using GraphPad Prisma. Results20 studies comprising of 5369 patients were included in this systemic review, which included 2 randomized control trails, 7 clinical prospective studies, 8 retrospective studies and 3 observational studies. ConclusionThis study suggests that aortic valve repair is a beneficial alternative available for younger adults suffering from aortic valve insufficiency in longer time.