| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
European Journal of Cardio-Thoracic Surgery, Vol 11, 258-265, Copyright © 1997 by European Association for Cardio-thoracic Surgery
HS Haydar, GW He, H Hovaguimian, DM McIrvin, DH King and A Starr
OBJECTIVE: Valve repair for aortic insufficiency may provide an alternative
to aortic valve replacement in selected patients. This repair could be an
attempt at permanent correction or palliation to allow the aortic annulus
to grow and avoid the use of anticoagulation. Based upon a five-year
experience, we proposed a classification according to valvular anatomy
which could be a guide to patient and procedure selection. METHODS: Between
September 1989 and February 1995, 44 consecutive patients underwent aortic
valvuloplasty for aortic incompetence at our institution. Patients' ages
ranged from 19 months to 76 years with a mean of 33 years. The etiology of
aortic incompetence was congenital in 30 patients, degenerative in 7
patients, rheumatic in 5 patients, and infective endocarditis in 2. Aortic
valve lesions were classified into three different types: type I, aortic
annular dilation (8 patients); type II, excessive aortic leaflet tissue (12
patients); and type III, restricted leaflet motion with or without
deficient leaflet tissue (24 patients). Type I needed commissural plication
in 7 patients; and aortic annuloplasty, which was simple in 6 patients, and
pericardial-augmented in 2. Type II necessitated midleaflet excision in 11
patients and leaflet plication in 7. Type III required leaflet extension in
19 patients, leaflet replacement in 1 patient, aortic valve commissurotomy
in 13 patients augmentation commissurorrhaphy in 2, leaflet shaving in 4,
and repair of leaflet perforation in 2. RESULTS: Postoperative
echocardiography revealed a significant decrease in the degree of aortic
incompetence. Mean follow- up was 2.6 +/- 1.4 years. There was no
mortality. Patients improved as is evident by NYHA functional class
postoperatively. Eight of the first 13 patients (18%) needed reoperation.
Three of these reoperations were bail-out procedures, and 3 patients (7%)
who underwent the leaflet extension technique were reoperated upon 19
months to 3 years later. Presently, 23 patients are without
anticoagulation, 11 take aspirin and 2 receive coumadin for combined mitral
procedures. CONCLUSIONS: Aortic valve repair provides a low risk option
with satisfactory intermediate- term results for the treatment of aortic
insufficiency in appropriately selected patients. Patient and procedure
selection may be based upon the echocardiographic anatomy of the aortic
valve, and a comparative risk benefit appraisal with valve replacement.
ARTICLES
Valve repair for aortic insufficiency: surgical classification and techniques
Albert Starr Academic Center for Cardiac Surgery, Portland, Oregon, USA. SamHaydar@gnn.com
This article has been cited by other articles:
|
|
 |
|
  L. de Kerchove, D. Glineur, A. Poncelet, M. Boodhwani, J. Rubay, W. Dhoore, P. Noirhomme, and G. El Khoury Repair of aortic leaflet prolapse: a ten-year experience Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 785 - 791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. B. Pettersson, A. C. Crucean, R. Savage, C. M. Halley, R. A. Grimm, L. G. Svensson, S. Naficy, A. M. Gillinov, J. Feng, and E. H. Blackstone Toward predictable repair of regurgitant aortic valves a systematic morphology-directed approach to bicommissural repair. J. Am. Coll. Cardiol., July 1, 2008; 52(1): 40 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Borer and L. N. Girardi Repair of the congenitally bicuspid regurgitant aortic valve a strategic advance. J. Am. Coll. Cardiol., July 1, 2008; 52(1): 50 - 51. [Full Text] [PDF]
|
|
|
|
|
|
E. Lansac, I. Di Centa, F. Raoux, N. A. Attar, C. Acar, T. Joudinaud, and R. Raffoul A lesional classification to standardize surgical management of aortic insufficiency towards valve repair Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 872 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Doss, S. Sirat, P. Risteski, S. Martens, and A. Moritz Pericardial patch augmentation for repair of incompetent bicuspid aortic valves at midterm Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 881 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]
|
|
|
|
 |
|
 D. Aicher, F. Langer, O. Adam, D. Tscholl, H. Lausberg, and H.-J. Schafers Cusp repair in aortic valve reconstruction: Does the technique affect stability? J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1533 - 1539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. McMullan, G. Oppido, B. Davies, Y. Kawahira, A. D. Cochrane, Y. d'Udekem d'Acoz, D. J. Penny, and C. P. Brizard Surgical strategy for the bicuspid aortic valve: Tricuspidization with cusp extension versus pulmonary autograft J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 90 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Hawkins, P. C. Kouretas, R. Holubkov, R. V. Williams, L. Y. Tani, J. T. Su, L. M. Lambert, C. R. Mart, M. D. Puchalski, and L. L. Minich Intermediate-term results of repair for aortic, neoaortic, and truncal valve insufficiency in children J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1311 - 1317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Watanabe, S. Saito, H. Saito, and H. Kurosawa Valve-sparing aortic root replacement with repair of leaflet prolapse after Ross operation Interactive CardioVascular and Thoracic Surgery, February 1, 2007; 6(1): 89 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. F. Lausberg, D. Aicher, F. Langer, and H.-J. Schafers Aortic valve repair with autologous pericardial patch. Eur. J. Cardiothorac. Surg., August 1, 2006; 30(2): 244 - 249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. El Khoury, J.-L. Vanoverschelde, D. Glineur, F. Pierard, R. R. Verhelst, J. Rubay, J.-C. Funken, C. Watremez, P. Astarci, V. Lacroix, et al. Repair of Bicuspid Aortic Valves in Patients With Aortic Regurgitation Circulation, July 4, 2006; 114(1_suppl): I-610 - I-616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Pretre, A. Kadner, H. Dave, D. Bettex, and M. Genoni Tricuspidisation of the aortic valve with creation of a crown-like annulus is able to restore a normal valve function in bicuspid aortic valves. Eur. J. Cardiothorac. Surg., June 1, 2006; 29(6): 1001 - 1006. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Odim, H. Laks, V. Allada, J. Child, S. Wilson, and D. Gjertson Results of Aortic Valve-Sparing and Restoration With Autologous Pericardial Leaflet Extensions in Congenital Heart Disease Ann. Thorac. Surg., August 1, 2005; 80(2): 647 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Talwar, C. Saikrishna, A. Saxena, and A. Sampath Kumar Aortic Valve Repair for Rheumatic Aortic Valve Disease Ann. Thorac. Surg., June 1, 2005; 79(6): 1921 - 1925. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Nash, E. Vitvitsky, J. Li, D. M. Cosgrove III, G. Pettersson, and R. A. Grimm Feasibility of Valve Repair for Regurgitant Bicuspid Aortic Valves--An Echocardiographic Study Ann. Thorac. Surg., May 1, 2005; 79(5): 1473 - 1479. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Massetti, E. Neri, D. Buklas, G. Babatasi, O. Le Page, J. L. Gerard, and A. Khayat Repair of Aortic Leaflet Prolapse: The "Sliding Leaflet Technique" Ann. Thorac. Surg., May 1, 2005; 79(5): 1787 - 1789. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Aicher, F. Langer, A. Kissinger, H. Lausberg, R. Fries, and H.-J. Schafers Valve-sparing aortic root replacement in bicuspid aortic valves: A reasonable option? J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 662 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Langer, D. Aicher, A. Kissinger, O. Wendler, H. Lausberg, R. Fries, and H.-J. Schafers Aortic Valve Repair Using a Differentiated Surgical Strategy Circulation, September 14, 2004; 110(11_suppl_1): II-67 - II-73. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. El Khoury, J.L. Vanoverschelde, D. Glineur, A. Poncelet, R. Verhelst, P. Astarci, M.J. Underwood, and Ph. Noirhomme Repair of aortic valve prolapse: experience with 44 patients Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 628 - 633. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Sun, Q. Wang, S. Hu, Y. Liu, L. Wang, and G. Gao A new technique for aortic valve dysfunction: reconstruction by posterior leaflet of tricuspid valve Ann. Thorac. Surg., July 1, 2004; 78(1): 348 - 351. [Full Text] [PDF]
|
|
|
|
|
|
N. Hasaniya, S. R. Gundry, A. J. Razzouk, N. Mulla, and L. L. Bailey Outcome of aortic valve repair in children with congenital aortic valve insufficiency J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 970 - 974. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Minakata, H. V. Schaff, K. J. Zehr, J. A. Dearani, R. C. Daly, T. A. Orszulak, F. J. Puga, and G. K. Danielson Is repair of aortic valve regurgitation a safe alternative to valve replacement? J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 645 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Carr and E. B. Savage Aortic valve repair for aortic insufficiency in adults: a contemporary review and comparison with replacement techniques Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 6 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kawazoe, H. Izumoto, J. Tsuboi, and J. Koizumi Tricuspidization of incompetent bicuspid aortic valve J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 908 - 910. [Full Text] [PDF]
|
|
|
|
|
|
H.-J. Schafers, D. Aicher, and F. Langer Correction of leaflet prolapse in valve-preserving aortic replacement: pushing the limits? Ann. Thorac. Surg., November 1, 2002; 74(5): S1762 - 1764. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Suematsu, T. Morota, H. Kubota, M. Ninomiya, and S. Takamoto Valve-sparing operation for aortic root aneurysm in patients with bicuspid aortic valve Ann. Thorac. Surg., September 1, 2002; 74(3): 907 - 908. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ahn, K.-H. Kim, and Y. J. Kim Midterm result of leaflet extension technique in aortic regurgitation Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 465 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Langer, T. Graeter, N. Nikoloudakis, D. Aicher, O. Wendler, and H.-J. Schafers Valve-preserving aortic replacement: Does the additional repair of leaflet prolapse adversely affect the results? J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 270 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Gillinov, E. H. Blackstone, J. White, M. Howard, R. Ahkrass, A. Marullo, and D. M. Cosgrove Durability of combined aortic and mitral valve repair Ann. Thorac. Surg., July 1, 2001; 72(1): 20 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Bacha, G. M. Satou, A. M. Moran, D. Zurakowski, G. R. Marx, J. F. Keane, and R. A. Jonas Valve-sparing operation for balloon-induced aortic regurgitation in congenital aortic stenosis J. Thorac. Cardiovasc. Surg., July 1, 2001; 122(1): 162 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-J. Schafers, F. Langer, D. Aicher, T. P. Graeter, and O. Wendler Remodeling of the aortic root and reconstruction of the bicuspid aortic valve Ann. Thorac. Surg., August 1, 2000; 70(2): 542 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. P. Casselman, A. M. Gillinov, R. Akhrass, V. Kasirajan, E. H. Blackstone, and D. M. Cosgrove Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet Eur. J. Cardiothorac. Surg., March 1, 1999; 15(3): 302 - 308. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
