title: Aortic valve-sparing repair with autologous pericardial leaflet extension has a greater early re-operation rate in congenital versus acquired valve disease.
abstract: OBJECTIVE
  We sought to establish whether there was a difference in outcome after aortic valve repair with autologous pericardial leaflet extension in acquired versus congenital valvular disease.
  
  
  METHODS
  One hundred and twenty-eight patients underwent reparative aortic valve surgery at our institution from 1997 through 2005 for acquired or congenital aortic valve disease. The acquired group (43/128) (34%) had a mean age of 56.4+/-20.3 years (range, 7.8-84.6 years) and the congenital group (85/128) (66%) had a mean age of 16.9+/-19.2 years (range, 0.3-82 years). The endpoints of the study were mortality and reoperation rates.
  
  
  RESULTS
  Thirty-day mortality was 0/43 (0%) in the congenital group and 1/85 (1.1%) in the acquired group. Late mortality in the acquired group was 3/43 (7%) and 3/84 (3.5%) in the congenital group (neither early nor late proportion of mortality is significantly different between the two groups, according to the nonparametric Binomial test for proportions). There were 13 total reoperations among 11 patients: 1/43 (2.3%) in the acquired group and 10/85 (11.7%) in the congenital group (p=0.07). Two patients from the congenital group were reoperated on twice. The mean interval between original repair and reoperation was 3.6+/-5 years (range, 0-7 years) for acquired and 3.5+/-2.5 years (range, 0-7 years) for the congenital group (Wilcoxon 2-sample test, p=0.7). Total early reoperation rate (<30 days after first surgery) was 11/128 (8.5%); for the congenital group 9/85 (10.5%) and for the acquired group 2/43 (4.6%). Early reoperation rate was significantly higher among the congenital group (p=0.013). The remaining patients are well at mean follow-up of 2.8+/-2.4 years (range 0-7.9). In the acquired group, the mean postoperative aortic regurgitation and stenosis grade by echocardiography was 0.5+/-0.3 (scale, 0-4) and 0.3+/-0.1, respectively. In the congenital group, the follow-up, mean aortic regurgitation and stenosis were 0.9+/-0.8 and 0.5+/-0.3, respectively.
  
  
  CONCLUSIONS
  There was no significant difference in early or late mortality and late reoperation rate between the two groups. Early reoperation rate was higher in the congenital versus the acquired aortic valvular disease group. This study supports the fact that the valve-sparing technique is safe and reproducible and repeatable in patients with acquired valve disease.
authors.affiliation: Division of Cardiac Surgery and Anatomic Pathology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Room 62-266B, CHS, Los Angeles, CA 90095-1741, United States.
authors.forename: David J
authors.initials: DJ
authors.lastname: De La Zerda
authors.forename: Oved
authors.initials: O
authors.lastname: Cohen
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fishbein
authors.forename: Jonah
authors.initials: J
authors.lastname: Odim
authors.forename: Carlos
authors.initials: C
authors.lastname: A Calderon
authors.forename: Diana
authors.initials: D
authors.lastname: Hekmat
authors.forename: Ivo
authors.initials: I
authors.lastname: Dinov
authors.forename: Hillel
authors.initials: H
authors.lastname: Laks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome