Conclusion
This novel technique -represented by what is a simple and easily
reproducible annulus plication- in this initial series of patients
appears to represent a simple and safe tool in the hands of the surgeon
to address cusp size discrepancy during AVNeo while avoiding commissure
movement.
This has not only significantly speeded up the exectution of this type
of procedure by more experienced surgeons, but has also made the
approach to AVNeo easier for surgeons in training.
Commissures shifting remains in use for all those patients whose
reduction by a single size of a cusp would not be sufficient to e
achieve cusp symmetry (with a discrepancy above 2 mm ) and also for
those patients in whom even a minimal reduction of the valveās
functional area could lead to patient-prosthesis mismatch (PPM) [4].
Further validation of this novel approach is needed in order to confirm
the initial positive findings in this first series of patients.