Aortic valve repair using a differentiated surgical strategy

Abstract

Background-Reconstruction of the aortic valve for aortic regurgitation (AR) remains challenging, in part because of not only cusp or root pathology but also a combination of both can be responsible for this valve dysfunction. We have systematically tailored the repair to the individual pathology of cusps and root. Methods-Between October 1995 and August 2003, aortic valve repair was performed in 282 of 493 patients undergoing surgery for AR and concomitant disease. Root dilatation was corrected by subcommissural plication (n = 59), supracommissural aortic replacement (n = 27), root remodeling (n = 175), or valve reimplantation within a graft (n = 24). Cusp prolapse was corrected by plication of the free margin (n = 157) or triangular resection (n = 36), cusp defects were closed with a pericardial patch (n = 16). Additional procedures were arch replacement (n = 114), coronary artery bypass graft (n = 60) or mitral repair (n = 24). All patients were followed-up (follow-up 99.6% complete), and cumulative follow-up was 8425 patient-months (mean, 33±27 months). Results-Eleven patients died in hospital (3.9%). Nine patients underwent reoperation for recurrent AR (3.3%). Actuarial freedom from AR grade ≥II at 5 years was 81% for isolated valve repair, 84% for isolated root replacement, and 94% for combination of both: actuarial freedom from reoperation at 5 years was 93%, 95%, and 98%, respectively. No thromboembolic events occurred, and there was 1 episode of endocarditis 4.5 years postoperatively. Conclusions-Aortic valve repair is feasible even for complex mechanisms of AR with a systematic and individually tailored approach. Operative mortality is low and mid-term durability is encouraging. The incidence of valve-related morbidity is low compared with valve replacement.