Cusp repair in aortic valve reconstruction: Does the technique affect stability?
Read at the Eighty-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5–9, 2007.
Received 6 April 2007; received in revised form 9 August 2007; accepted 27 August 2007. published online 29 October 2007.
Objective
Cusp prolapse may be an isolated cause of aortic regurgitation or may exist in conjunction with dilatation of the proximal aorta. Prolapse can be corrected by central plication, triangular resection, or pericardial patch implantation. We retrospectively analyzed our results with these techniques.
Methods
From October 1995 to December 2006, 604 patients (aged 3–86 years) underwent aortic valve repair. Cusp prolapse was found in 427 patients (246 tricuspid, 181 bicuspid). Prolapse was corrected by central plication (n = 275) or triangular resection (n = 80). A pericardial patch was implanted for pre-existing cusp defects or after excision of calcium (n = 72). One cusp was repaired in 198 patients; the remaining patients underwent repair of 2 (n = 189) or 3 cusps (n = 40). In 102 patients more than one technique was used, and the patients were allocated to the group of the assumedly more complex repair (central plication < triangular resection < pericardial patch plasty). Cumulative follow-up was 1238 patient-years (mean 35 ± 27 months).
Results
Hospital mortality was 2.6% (11/427). Actuarial freedom from aortic regurgitation of grade II or more at 5 years was 92% (central plication), 90% (triangular resection), and 90% (pericardial patch plasty). Thirteen patients were reoperated on, with prolapse as the most common reason for failure (n = 7); 6 underwent re-repair. Freedom from reoperation at 5 years was 95% (central plication), 94% (triangular resection), and 94% (pericardial patch plasty). Freedom from valve replacement at 5 years was 97% (central plication), 99% (triangular resection), and 98% (pericardial patch plasty).
Conclusions
In aortic valve repair, cusp prolapse can be treated reliably by central plication. In the presence of more complex disease, triangular resection or pericardial patch plasty may be used without compromising midterm durability.
Department of Thoracic and Cardiovascular Surgery, University of Saarland Homburg/Saar, Germany.
Address for reprints: H.-J. Schäfers, MD, Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, 66421 Homburg/Saar, Germany
ABSTRACT