Midterm result of leaflet extension technique in aortic regurgitation

Aortic valve leaflet extension using glutaraldehyde-fixed autopericardium in aortic regurgitation (AR) is technically demanding, and it is not a popular procedure among surgeons. This study evaluates the effectiveness and clinical feasibility of the leaflet extension technique as a treatment modality for AR.

From March 1995 to March 2001, 34 consecutive patients underwent the leaflet extension technique. The mean age of the 26 men and eight women was 31.0+/-14.3 years (range 16-68). They were all diagnosed with pure aortic valve regurgitation, and nine (27.3%) had associated mitral valvular heart diseases. Accurate measurement of the leaflet free margins was performed with a pair of compasses before leaflet extension. Glutaraldehyde-fixed autopericardium was designed according to the free margin lengths. Leaflet extension was performed in three aortic leaflets for 29 patients but only one leaflet was extended in the remaining four. The nine patients with associated mitral valvular heart disease also underwent mitral valvuloplasty. Mean cardiopulmonary bypass time and ischemic time in 25 isolated AR group were 128.7+/-26.5min (range 70--180) and 101.5+/-25.5min (range 41-150), respectively.

There was no incidence of in-hospital mortality. Immediate postoperative echocardiography revealed grade II AR in one, grade I AR in ten and no AR in the remaining 23 patients. Mean follow-up duration was 49.6+/-18.8 months (range 4.1-77.1). Echocardiographic AR grades during follow-up were grade II in 13, grade I in 11 and no AR in eight. The remaining two patients underwent reoperation, one aortic valve replacement because of subacute bacterial endocarditis that occurred 7 months after leaflet extension, and the other Ross operation because of the dehiscence of the valvuloplasty suture site that developed 4 months later (AR associated with Behcet's disease). There was one case of mortality due to malignant mesothelioma 4 years after aortic valvuloplasty. The cumulative survival rate was 94.1% at 5 years. Freedom from reoperation was 93.8% at 1 year and after.

The leaflet extension technique is an acceptable surgical treatment modality for AR and its clinical results were confirmed in this study to be very good. A careful long-term follow-up study will be necessary to evaluate the long-term durability of the glutaraldehyde-preserved autologous pericardium as a leaflet tissue.