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.
Konstantinov
B A
BA
Research Center of Surgery, Russian Academy of Medical Sciences, Moscow.
Dzemeshkevich
S L
SL
Ivanov
V A
VA
Sandrikov
V A
VA
Rikunov
J
J
D001021:Aortic Valve / Q000601:surgery* / Q000637:transplantation; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D012086:Reoperation; D013537:Sutures; D013997:Time Factors