Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material

Myers, Patrick O.; Tissot, Cécile; Christenson, Jan T.; Cikirikcioglu, Mustafa; Aggoun, Yacine; Kalangos, Afksendiyos

doi:10.1016/j.jtcvs.2010.06.036

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 4 , Pages 836-844, October 2010

Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material

Read at the 90th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 1–5, 2010.

Patrick O. Myers, MD
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
- Division of Cardiac Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass
- Address for reprints: Patrick O. Myers, MD, Division of Cardiovascular Surgery, Geneva University Hospital and School of Medicine, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
Cécile Tissot, MD
- Pediatric Cardiology Unit, Children's Hospital and Geneva University Hospitals, Geneva, Switzerland
Jan T. Christenson, MD
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
Mustafa Cikirikcioglu, MD, PhD
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
Yacine Aggoun, MD
- Pediatric Cardiology Unit, Children's Hospital and Geneva University Hospitals, Geneva, Switzerland
Afksendiyos Kalangos, MD, PhD, FECTS
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland

Received 13 January 2010; received in revised form 22 March 2010; accepted 28 June 2010. published online 26 July 2010.

Objective

Aortic valve repair has encouraging midterm results in selected patients. However, neither the long-term results of cusp extension nor the durability of different pericardial fixation techniques has been reported. Our goal was to address these issues.

Methods

Seventy-eight children with severe rheumatic aortic regurgitation (mean age 12 ± 3.5 years) underwent aortic valve repair using cusp extension over a 15-year period, with fresh autologous pericardium in 53 (67.9%), glutaraldehyde-fixed bovine pericardium in 9 (11.5%), and PhotoFix bovine pericardium (Sorin CarboMedics, Milano, Italy) in 16 (20.5%). Fifty-seven children (73.1%) underwent concomitant mitral valve repair, and 8 children (10.3%) underwent tricuspid valve repair.

Results

There was 1 operative death from left ventricular failure. During a median follow-up of 10.7 years (range 1 month to 16.4 years), 1 late death occurred and 15 patients (19.7%) required reoperation at a mean of 43 ± 33.7 months (range 1 month to 9 years), 9 within the autologous pericardium group (18%), 3 within the bovine pericardium group (33%), and 3 within the PhotoFix pericardium group (19%). Freedom from reoperation was 96% ± 2.3% at 1 year, 87.5% ± 3.9% at 5 years, 80.7% ± 4.9% at 10 years, and 75.3% ± 6% at 15 years, and was significantly decreased in the bovine pericardium group (P = .039). On multivariable analysis, greater age (hazard ratio 1.25, P < .001) and acute rheumatic carditis (hazard ratio 8.15, P = .001) at operation were significant predictors of reoperation.

Conclusions

Aortic cusp extension provides adequate valve repair in a large proportion of children with rheumatic aortic regurgitation. Fresh autologous and PhotoFix pericardium trended toward better durability than glutaraldehyde-fixed bovine pericardium.

CTSNet classification: 20.2, 35.1

Abbreviations and Acronyms: AI, aortic insufficiency, AV, aortic valve, HR, hazard ratio, LVEDD, left ventricular end-diastolic diameter, LVESD, left ventricular end-systolic diameter, MV, mitral valve