Long-term results of the leaflet extension technique in aortic regurgitation: thirteen years of experience in a single center.
BACKGROUND
We evaluated the effectiveness and durability of the leaflet extension technique for correction of aortic regurgitation (AR) and the long-term clinical results.


METHODS
Between March 1995 and August 2004, 41 consecutive patients were included. The mean age was 32.2 +/- 13.9 years. The causes of AR were rheumatic in 31 patients (75.5%), degenerative in 2 patients (4.9%), bicuspid aortic valve in 4 patients (9.8%), infective endocarditis in 1 patient (2.4%), and congenital in 3 patients (7.3%). Leaflet extensions were performed in three leaflets for 32 patients, two leaflets for 3 patients, and only one leaflet for 6 patients. The mean follow-up duration was 92.9 +/- 48.4 months.


RESULTS
There were no early deaths and 2 late deaths. One patient died of cancer and the other patient died of infective endocarditis. The cardiac-related mortality was 2.4% (1 of 41 patients). During a mean follow-up of 7 years, severe AR was detected in 1 patient and moderate AR in 6 patients (17.0%; 7 of 41 patients). The causes of recurrent AR were infective endocarditis in 3 patients, disease progression in 3 patients, and Behçet's diseases in 1 patient. We performed 6 reoperations (14.6%), 3 in patients owing to infective endocarditis, 2 in patients owing to disease progression, and 1 in a patient owing to the suture dehiscence associated with Behçet's disease. The cumulative survival was 92.6% at 13 years. Freedom from recurrent AR was 97.5% at 5 years, 81.7% at 10 years, and 68.1% at 13 years.


CONCLUSIONS
The long-term durability of the leaflet extension technique was acceptable. The reoperations increased with time, but pericardial leaflet dysfunction was not the cause.
Jeong
Dong Seop
DS
Department of Thoracic and Cardiovascular Surgery, Seoul National University Borame Medical Center, Seoul, South Korea.
Kim
Kyung-Hwan
KH
Ahn
Hyun
H
D000328:Adult; D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002815:Chordae Tendineae / Q000601:surgery*; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous; D055815:Young Adult