A North American first at the Montreal Heart Institute


An innovative procedure called an aortic valve annuloplasty was successfully carried out at the Montreal Heart Institute saving the life of a young man in his thirties. This North American first was performed by cardiac surgeon Dr. Ismail El-Hamamsy, who was assisted by a multidisciplinary team. The procedure consists of preserving the aortic valve by implanting a prosthetic ring around the aorta to bring the valve flaps together by reducing and reinforcing the valvular opening.

The patient who underwent the procedure suffered from an aortic root aneurysm‏—a congenital problem that causes the aortic valve to leak extensively. Instead of replacing the valve with a mechanical prosthesis, Dr. El-Hamamsy decided to repair the patient’s native valve using a ring implanted around the aortic root to restore the valve’s non-leaking shape. “This procedure is ideal for younger patients, as it provides excellent long-term outcomes and keeps the patient off lifelong anticoagulant medication to thin the blood, which would be necessary with a mechanical prosthesis,” stated Dr. El-Hamamsy. “This surgical innovation is in keeping with the tradition of advances started at the MHI a number of years ago by Dr. Raymond Cartier.”

Developed and manufactured by Montreal-based CORONEO and marketed as the Extra-Aortic Ring, this new device is elastic and designed to maintain the natural shape as well as the mobility and flexibility of the valve opening. It mimics the elasticity of the arteries and allows the aortic valve to maintain natural movement.

Extra-Aortic Ring: European Trial

Designed specifically to repair the aortic valve, the Extra-Aortic Ring is the first aortic annuloplasty device to obtain CE marking (EU regulatory approval). In France, the device was successfully implanted in a cohort of 130 patients as part of a prospective multi-centre clinical trial called CAVIAAR (Conservative Aortic Valve Surgery for Aortic Insufficiency and Aneurysms of the Aortic Root). In accordance with the CAVIAAR protocol, a standardized technique for implanting the Extra-Aortic Ring was created.

For this first North American procedure, Dr. El-Hamamsy was assisted by Dr. Emmanuel Lansac, a cardiac surgeon from the Institut Mutualiste Montsouris in Paris, inventor of the aortic ring and principal investigator of the CAVIAAR trial. The Extra-Aortic Ring was implanted at the Montreal Heart Institute under the Special Access Program, which allows practitioners to use medical devices in advance of regulatory approval from Health Canada.

About aortic dilation
The aortic valve is required for the heart to pump, as it allows blood to exit from the left ventricle into the aorta. The tissue supporting the opening of the aortic valve can sometimes become weakened. When this happens, the valve no longer seals, which strains the heart due to the backflow of blood into the left ventricle with each heart beat. If the opening dilates too much, the wall of the aorta can even tear. Surgery is then necessary to protect the heart and prevent the risk of aortic rupture.