Long-term results of plastic reconstructions in acquired aortic valvular disease

Plastic surgery in acquired aortic valvular disease was performed in 164 patients. Among them, 9 had the isolated aortic valvular injury; 130 mitral-aortic defects; and 25 three-valve injuries. The restoration of the injured valve function was achieved, as a rule, using a combination of surgical methods: commissurotomy or wedge resection of the fibrous tissue in the commissurial area; parietal resection; the aortic root frame plasty; perforation hole plasty; the allogenic valvuloaortic complex sector transplantation; and wedge resection or isometric cusp plication in the commissurial area. Calcinosis was not a contraindication to surgery, if it could be removed completely without the cusp closing function disturbances. The hospital mortality rate was 8%. After hospital treatment all the patients were followed-up: 108 for over 1 year, and the maximum term of the follow-up was 7 years. From 1 to 4 years postoperatively, 4 patients were reoperated due to the appearance of aortic insufficiency. The causes of relapse were: infectious endocarditis (3 patients); active rheumatic process (1 patient); and progressive dilatation of the fibrous ring (1 patient). During the follow-up 8 patients died: 6 of infectious endocarditis with mitral prosthetic injury; and in 2 the cause of death was not clear. The study of immediate and long-term aortic valvuloplasty results based on the clinical experience of 164 operations allows to recommend the elaborated principles of the aortic valve surgical reconstruction for a wide application in cardiac surgery.