title: Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve?
abstract: OBJECTIVE
  There is lack of information regarding the long-term behavior of aortic valve reconstruction with pericardium (AoR). A 16-year follow-up is reported here.
  
  
  METHODS
  Between 1988 and 1995, 92 consecutive patients had AoR with bovine (Group I, n=27) or glutaraldehyde-treated autologous pericardium (Group II, n=65). The mean age was 30 years (range 12-68). There were 65% males, 92% in sinus rhythm, 84% had rheumatic etiology and 36% had 'other valve' surgery. Mitral valve replacement with a mechanical prosthesis is a contraindication to the operation.
  
  
  RESULTS
  Hospital mortality was 2%. The reconstructed aortic valve performed well with excellent hemodynamics. The mean follow-up interval was 10.5+/-4 years, range 9-16 years (longer for group I,12 versus 10 years) with 4% late deaths and seven patients lost to follow-up. Survival rate was 85+/-4%. There were no episodes of thromboembolism. Freedom from reoperation for the whole group was 68+/-5% at 10 years and 47+/-6% at 16 years. For group I, it was 68+/-9% at 10 years and 48+/-10% at 16 years, while for group II it was 72+/-6 and 45+/-8% at 10 and 15 years, respectively. Excluding endocarditis (one in group I and seven in group II) and 'other' reasons for reoperation (two in group I and three in group II), the freedom from structural valve degeneration (SVD) at 10 and 16 years was 78+/-1 and 55+/-10% for group I. For group II, it was 80+/-5% at 10 years and 58+/-9% at 15 years. The mean interval at which the valve degenerated was 8.8 years+/-3.6 and did not differ between the two groups.
  
  
  CONCLUSIONS
  AoR is feasible with good hemodynamics, low mortality and thromboembolic rate. Its behavior at 10 years is comparable to that of stentless aortic valve bioprosthesis. It can be performed with either xenopericardium or glutaraldehyde-treated autologous pericardium, but the latter has the advantage of being inexpensive and readily available.
authors.affiliation: King Faisal Heart Institute at King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, MBC-16, Riyadh 11211, Saudi Arabia. alhalees@kfshrc.edu.sa
authors.forename: Zohair
authors.initials: Z
authors.lastname: Al Halees
authors.forename: Maie
authors.initials: M
authors.lastname: Al Shahid
authors.forename: Aly
authors.initials: A
authors.lastname: Al Sanei
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sallehuddin
authors.forename: Carlos
authors.initials: C
authors.lastname: Duran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002648:Child; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D016896:Treatment Outcome