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Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results
Jean-Michel Grinda1, Christian Latremouille, Alain J Berrebi
1Department of Cardiac Surgery, Hôpital Européen Georges Pompidou, Paris University, France. jean-michel.grinda@egp.ap-hop-paris.fr
Insights
This study shows that autologous pericardium cusp extension is a safe and effective technique for repairing rheumatic aortic insufficiency in young patients, avoiding the need for prosthetic valves and lifelong anticoagulation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Rheumatic Heart Disease
Background:
- Surgical management of rheumatic aortic insufficiency in the young is challenging due to prosthetic valve replacement drawbacks.
- Autologous pericardium cusp extension offers a solution for young patients, especially those unable to undergo long-term anticoagulation therapy.
Purpose of the Study:
- To evaluate the efficacy and safety of glutaraldehyde-preserved autologous pericardium cusp extension for rheumatic aortic insufficiency in young patients.
- To assess the midterm outcomes of this valvuloplasty technique in a pediatric and young adult population.
Main Methods:
- 89 consecutive patients (mean age 16 years) underwent triple pericardial aortic cusp extension valvuloplasty.
- The technique involved free edge aortic cusp extension using glutaraldehyde-stabilized autologous pericardium strips.
- Procedures included isolated aortic repair, combined aortic and mitral repair, or triple valve repair.
Main Results:
- Hospital mortality was 2.2%, with primary aortic repair failure in 2 patients.
- At 5 years, actuarial survival was 96.4%, and 92.1% were free from redo valvular surgery.
- At 7 years, 90% were free from valve-related complications, with some developing mild insufficiency.
Conclusions:
- Midterm results of autologous pericardium aortic cusp extension are encouraging for young rheumatic patients.
- This technique is a viable alternative, allowing annular growth and delaying the need for prosthetic valves and anticoagulation.
- It serves as an effective palliative procedure for managing aortic insufficiency in this specific population.
Background:
The surgical management of rheumatic aortic insufficiency in the young remains problematic owing to the drawbacks of prosthetic valve replacement at this age. In young foreign patients, for whom long-term anticoagulation therapy is unavailable, we have used a glutaraldehyde preserved autologous pericardium cusp extension technique to repair rheumatic aortic valve insufficiencies resulting from cusp retractions.
Methods:
From September 1992 to December 2000, 89 consecutive patients with a mean age of 16 +/- 5 years underwent triple pericardial aortic cusp extension valvuloplasty. Eighty patients had pure aortic insufficiency, 9 had mixed aortic disease. Twenty-nine patients (33%) had isolated aortic valve disease and 60 patients (69%) had combined aortic and mitral valve disease with significant tricuspid valve disease in 21 (24%). Aortic repair consisted of free edge aortic cusp extension using three rectangular strips of glutaraldehyde stabilized autologous pericardium. Twenty-nine patients (33%) underwent an isolated aortic repair, 39 patients (44%) underwent combined aortic and mitral procedures (34 mitral repairs, 3 mitral homografts, and 2 prosthesis replacements), and 21 patients (23%) underwent a triple valve repair.
Results:
The hospital mortality was 2.2%. Primary failure of the aortic repair requiring immediate reoperation occurred in 2 patients. During follow-up (mean of 62 +/- 22 months) 1 patient died and 7 underwent redo valvular surgery. At 5 years the actuarial survival rate was 96.4%, and 92.1% of the patients were free from redo valvular surgery. At 7 years 90% of the patients were free from valve-related complications. Among the 76 patients free from redo valvular surgery at follow-up, 6 had deterioration of the repair resulting in grade II aortic and mitral insufficiencies.
Conclusions:
Our midterm results of glutaraldehyde stabilized autologous pericardial aortic cusp extension are encouraging and suggest that this technique should be considered as a viable alternative palliative procedure in a young rheumatic population, allowing for growth of the annulus and delaying to a less critical period the need for the lifelong anticoagulation therapy required for a prosthetic mechanical valve.