Aortic valve repair with pericardial leaflet extension for aortic valve insufficiency

Abstract

IntroductionThe surgical correction of aortic insufficiency in children and young adults remains a challenge. Homograft replacement and the Ross procedure represent the standard approach with predictable but not perfect results. Reparative procedures may provide a reasonable alternative in some clinical and social settings. The purpose of this report is to provide the intermediate results in which leaflet extension with autologous glutaraldehyde preserved pericardium is utilized. MethodsOf 60 patients that had aortic valve repair predominantly for aortic regurgitation from 1990 to 1999, 16 patients had aortic regurgitation with deficient leaflet tissues so that repair was performed with pericardial leaflet extension. There were 11 male (69%) and 5 female (31%) patients. The mean patient age was 26.6 years, range 1.6 -75.5 years. Three patients had previous aortic commissurotomy and 1 patient had repair of aortic coarctation. Preoperatively, 2 patients (13%) were in NYHA class I, 12 patients (75%) were in NYHA class II and 2 patients (13%) were in NYHA class III.Of the 16 patients, 6 patients (38%) had a bicuspid aortic valve and 10 patients (63%) had a tricuspid aortic valve. None of the patients had mild aortic insufficiency. Indications for surgery were moderate aortic valve insufficiency in 8 patients (50%) and severe aortic insufficiency in 8 patients (50%). One patient had concomitant mitral valve replacement and Abstract Background: This article presents our intermediate term results of pericardial leaflet extension used in various complex pathologies of the aortic valve leading to aortic regurgitation.Methods: Sixteen patients had aortic insufficiency/regurgitation with deficient leaflet tissues so that repair was performed with pericardial leaflet extension. The mean patient age was 26.6 years and 69% were male. Two patients (13%) were in NYHA class I, 12 patients (75%) were in class II and 2 patients (13%) were in class III preoperatively. Six patients (38%) had a bicuspid aortic valve and 10 patients (63%) had a tricuspid aortic valve. Eight patients (50%) had moderate and 8 patients (50%) had severe aortic insufficiency (AI) preoperatively. Two patients (13%) had associated cardiac procedures at the time of aortic repair.Results: There were no operative deaths but 3 patients died in the late postoperative period. Five patients underwent subsequent aortic valve replacement or a Ross procedure at re-operation. The most common finding during re-operation was thickening of the leaflet extension or rolling in of the edges of the leaflet extension. Freedom from aortic valve re-operation at five years postoperation was 68% (standard error 14). Late follow-up revealed that 9 patients (56%) were in NYHA class I and 7 patients (44%) were in class II. Ten (63%) patients had mild AI and 6 patients (37%) had moderate AI at most recent follow-up.Conclusions: Absence of hospital mortality, freedom from embolic events and echocardiography evidence of immediate competency of the valve are the reliable indicators of thi...