Rheumatic Fever (RF) after streptococcal infections is the leading cause of valvular heart disease in developing countries,  said to be responsible for 400,000 deaths all over the world, each year mostly among children and young adults. It is estimated that the RF currently affects at least 12 millions people, including 2 millions in need of repeated hospitalizations and 1 million for whom a cardiac surgery is often unaffordable, will prevail in the twenty coming years. This condition - caused by poverty and high population density - can be considered as a serious public health problem in developing countries, hence the need for preventive measures is there. 

The geographical belt of RF and of the rheumatic carditis extends from some Latin American countries, in Southeast Asia through the Maghreb, some African countries and the Middle East. The incidence rate of RF in Europe is 2 per 100,000 inhabitants while it varies between 50 and 200 in developing countries. With little prevention being done, the major way to stop this development at this stage is finally cardiac surgery. 

Faced with a situation of very young patient population, anticoagulation-related problems, poor economical conditions and a possible limited durability of bioprotheses, some surgical teams used first aortic cusps extension with pericardium as an alternative to prostheses. Evolution of repair techniques using a tricuspid valve awakened interest in aortic valve repair which had to be a total reconstruction according to universal acceptance. The major problem  remained the reproducibility of the technique itself. 

For this reason Professor Wajih Maazouzi, MD and his team developed with GEISTER a new device, the Maazouzi™ Aortic Plasty Sizer (APS™), allowing to overcome the difficulties of manufacturing and inserting a new extemporanous aortic valve made of autologous pericardium, suitable for any case of aortic valve disease and for any size of annulus. The Maazouzi APS™ is a device allowing both confection and insertion of a total aortic valvular stentless autograft made of patient pericardium. It is composed of a holder, 3 stamps and a matrix. It is available in seven sizes 19-31mm for adults and in sizes 11-17mm for pediatric use.  The transparent moulds are marked with a white line allowing visualisation of adequate position of the pericardium introduced between the matrix and the stamps. 

While the development of the device was a response to the difficulties fhe cardiac surgeons were facing while trying to produce an extemporaneous pericardial valve, its development also included the large economic interest in reducing costs of cardiac valve surgery, sparing the purchase of a mechanical or biological valve prothesis, that in some regions makes up to about 25%-35% of the total cost of the surgery.  Regions, where RF is widespread among the most disadvantaged population and thus the poorest and the cost of  an operation can be corresponding to up to 25-75 times the minimum wage. 

Furthermore, the device should also help to improve the quality and results of valvular surgery, as it uses tissue from the patient himself (autograft), which is organic and therefore recognized and accepted by the body. So, the technique is also saving the life-long anticoagulant treatment and avoids the patient going through a monthly monitoring and blood tests.