Aortic valve repair: the functional approach to leaflet prolapse and valve-sparing surgery.
BACKGROUND
Combined aortic valve repair and aortic valve-sparing surgery requires an approach determined by the leaflets and aortic root anatomy.


METHODS
Among patients referred for aortic root aneurysm, 114 patients underwent an aortic valve-sparing procedure in which a reimplantation or remodelling technique was used. The Gelweave Valsalva prosthesis (Sulzer Vascutek, Renfrewshire, UK) was used in 45 patients. Better molding of the prosthesis on the aortic annulus was achieved by a low proximal dissection and incisions on the prosthesis to respect the anatomy of the aortoventricular junction. The reimplantation technique was used in 58%, and 62% of all patients underwent an associated leaflet procedure.


RESULTS
The operative mortality rate was 1%, with a 2% immediate reoperation rate. During the mean follow-up 50 +/- 35 months, 3 patients (2.6%) needed reoperation for recurrent aortic regurgitation (n = 2) or aortic stenosis (n = 1). At the end of follow-up, aortic regurgitation grade exceeding 2 had occurred in 2.6% of patients (n = 3), and 98.2% were in New York Heart Association functional class 1 or 2. Neither the early nor mid-term results showed any differences among the different surgical techniques used (reimplantation, remodeling, Valsalva prosthesis, additional leaflet repair).


CONCLUSIONS
A complete approach to the different components of the aortic root allows good clinical results at mid-term.
Jeanmart
Hugues
H
Department of Cardiovascular and Thoracic Surgery, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium. hjeanmart@yahoo.com
de Kerchove
Laurent
L
Glineur
David
D
Goffinet
Jean-Michel
JM
Rougui
Ishan
I
Van Dyck
Michel
M
Noirhomme
Philippe
P
El Khoury
Gebrin
G
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D001023:Aortic Valve Prolapse / Q000150:complications / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012092:Replantation / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome