Sinotubular Stabilization in Isolated Tricuspid and Quadricuspid Aortic Valve Repair

The primary goal in aortic valve repair is the correction of the mechanism of aortic regurgitation (AR); different mechanisms have been characterized, such as annular dilatation.1,2 In tricuspid (TAV) and quadricuspid aortic valves (QAV), sinotubular junction (STJ) diameter is likewise important for valve form and function.2–7 Its dilatation can lead or contribute to AR,2–4 and its correction can normalize valve function.4–7 The best management of ST dilatation, however, is not yet clear. In root aneurysm and tubular aortic aneurysm, aortic replacement will reduce and stabilize the STJ. Such operations appear overly aggressive in the presence of milder forms of aortic or STJ dilatation. An expandable ring implanted at the STJ level has been propagated.8 This implies potential drawbacks, including distortion of cusp configuration through possible asymmetric placement of the commissures. We have employed a circumferential polytetrafluoroethylene (PTFE) suture to reduce the STJ in conjunction with TAV and QAV repair for the correction of STJ enlargement. The suture is placed during cardioplegic arrest without fixing it at specific points to allow for self-adjustment when the aorta is pressurized. It is tied under echocardiographic control after completion of valve repair with the heart beating, adjusting STJ dimensions according to the echocardiographic and functional assessment.