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Eur J Cardiothorac Surg 2007;31:256-260. doi:10.1016/j.ejcts.2006.11.027
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Aortic valve-sparing repair with autologous pericardial leaflet extension has a greater early re-operation rate in congenital versus acquired valve disease

^a Division of Cardiac Surgery and Anatomic Pathology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Room 62-266B, CHS, Los Angeles, CA 90095-1741, United States
^b Department of Statistics and Center for Computational Biology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Room 62-266B, CHS, Los Angeles, CA 90095-1741, United States

Received 7 September 2006; received in revised form 10 November 2006; accepted 16 November 2006.

^_* Corresponding author. Address: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Room 62-266B, CHS, Los Angeles, CA 90095-1741, United States. Tel.: +1 760 815 4749; fax: +1 310 8257473. (Email: ddelazerda{at}gmail.com).

Objective: We sought to establish whether there was a difference in outcome after aortic valve repair with autologous pericardial leaflet extension in acquired versus congenital valvular disease. Methods: One hundred and twenty-eight patients underwent reparative aortic valve surgery at our institution from 1997 through 2005 for acquired or congenital aortic valve disease. The acquired group (43/128) (34%) had a mean age of 56.4 ± 20.3 years (range, 7.8–84.6 years) and the congenital group (85/128) (66%) had a mean age of 16.9 ± 19.2 years (range, 0.3–82 years). The endpoints of the study were mortality and reoperation rates. Results: Thirty-day mortality was 0/43 (0%) in the congenital group and 1/85 (1.1%) in the acquired group. Late mortality in the acquired group was 3/43 (7%) and 3/84 (3.5%) in the congenital group (neither early nor late proportion of mortality is significantly different between the two groups, according to the nonparametric Binomial test for proportions). There were 13 total reoperations among 11 patients: 1/43 (2.3%) in the acquired group and 10/85 (11.7%) in the congenital group (p = 0.07). Two patients from the congenital group were reoperated on twice. The mean interval between original repair and reoperation was 3.6 ± 5 years (range, 0–7 years) for acquired and 3.5 ± 2.5 years (range, 0–7 years) for the congenital group (Wilcoxon 2-sample test, p = 0.7). Total early reoperation rate (<30 days after first surgery) was 11/128 (8.5%); for the congenital group 9/85 (10.5%) and for the acquired group 2/43 (4.6%). Early reoperation rate was significantly higher among the congenital group (p = 0.013). The remaining patients are well at mean follow-up of 2.8 ± 2.4 years (range 0–7.9). In the acquired group, the mean postoperative aortic regurgitation and stenosis grade by echocardiography was 0.5 ± 0.3 (scale, 0–4) and 0.3 ± 0.1, respectively. In the congenital group, the follow-up, mean aortic regurgitation and stenosis were 0.9 ± 0.8 and 0.5 ± 0.3, respectively. Conclusions: There was no significant difference in early or late mortality and late reoperation rate between the two groups. Early reoperation rate was higher in the congenital versus the acquired aortic valvular disease group. This study supports the fact that the valve-sparing technique is safe and reproducible and repeatable in patients with acquired valve disease.

Key Words: Aortic valve • Repair • Cardiac surgery

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				D. S. Jeong, K.-H. Kim, and H. Ahn Long-term results of the leaflet extension technique in aortic regurgitation: thirteen years of experience in a single center. Ann. Thorac. Surg., July 1, 2009; 88(1): 83 - 89. [Abstract] [Full Text] [PDF]