Aortic annuloplasty: a new aspect of aortic valve repair.

study because this is the technique that has been the most used in clinical practice for ventriculo-aortic junction reduction and stabilization. Of course, it has an effect on valve coaptation. It increased the coaptation by plications, or if you prefer, by closing the subcommissural triangle. This portion of the aortic root is just above what we considered to be the ventriculo-aortic junction, so I think it must be considered as a VAJ annuloplasty. Regarding your second question, we have seen that after noncircumferential annuloplasty, as with subcommissural annuloplasty, you may have recurrent dilatation because the portions between the plication are not supported. We have also observed that the pledget used in subcommissural annuloplasty stitches can migrate inside the aortic wall. Those are the mechanisms explaining the loss of efficacy over time of the subcommissural annuloplasty. With a prosthetic ring annuloplasty, as in the reimplantation technique, for example, you stabilize the annulus circumferentially with a prosthesis, as you also do in mitral or tricuspid annuloplasty. You really have another reinforcement of the annulus than happens with subcommissural annuloplasty. Long-term follow-up data on mitral and tricuspid valve repair or on the Tirone David operation suggest that the annuloplasty rings are probably more stable than the de Vega annuloplasty or the subcommissural annuloplasty.