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 valve’s 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.