Cusp repair in aortic valve reconstruction: does the technique affect stability?

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Aortic Valve Disease

Background:

• Cusp prolapse is a significant cause of aortic regurgitation, sometimes associated with proximal aortic dilatation.
• Surgical correction options for cusp prolapse include central plication, triangular resection, and pericardial patch implantation.

Purpose of the Study:

• To retrospectively analyze the outcomes of different surgical techniques for aortic valve repair due to cusp prolapse.
• To evaluate the midterm durability and effectiveness of central plication, triangular resection, and pericardial patch implantation.

Main Methods:

• A retrospective analysis of 604 patients undergoing aortic valve repair between October 1995 and December 2006.
• Cusp prolapse was identified in 427 patients and corrected using central plication (n=275), triangular resection (n=80), or pericardial patch (n=72).
• Follow-up averaged 35 months, totaling 1238 patient-years, to assess freedom from aortic regurgitation, reoperation, and valve replacement.

Main Results:

• Hospital mortality was 2.6%. Five-year actuarial freedom from grade II or higher aortic regurgitation was 90-92% across techniques.
• Five-year freedom from reoperation was high (94-95%), with prolapse being the most common reason for failure (n=7).
• Five-year freedom from valve replacement was excellent, ranging from 97% to 99% depending on the repair method.

Conclusions:

• Central plication is a reliable method for treating aortic cusp prolapse during valve repair.
• Triangular resection and pericardial patch plasty offer durable midterm results for more complex cusp prolapse cases.
• These techniques provide effective solutions for aortic regurgitation caused by cusp prolapse, minimizing the need for valve replacement.