title: Cusp prolapse repair in trileaflet aortic valves: free margin plication and free margin resuspension techniques.
abstract: BACKGROUND
  Cusp prolapse management is important in aortic valve (AV) sparing and repair to achieve durable results. We analyzed the midterm outcomes of two different techniques for trileaflet AV prolapse repair.
  
  
  METHODS
  Between 1996 and 2008, 376 patients underwent elective AV repair: 88 with trileaflet AV (23%) had cusp prolapse repair, plication technique was performed in 34 (39%), resuspension technique in 33 (37%) and plication plus resuspension in 21 (24%). One cusp was repaired in 55 (62%), 2 cusps in 18 (21%), and 3 cusps in 15 (17%).
  
  
  RESULTS
  No hospital deaths occurred. Patients undergoing resuspension with or without plication had more preoperative aortic insufficiency (AI; p = 0.01) and multiple cusp prolapses (p = 0.01). During follow-up (median, 41 months), 4 deaths occurred and 2 were cardiac related. Overall survival at 5 years was 95% +/- 5%. Two patients needed AV reoperation because of recurrent AI or AI plus AV stenosis. Recurrent AI grade > or =3+ developed in 4 patients; 1 with moderate AV stenosis. Freedom from reoperation at 5 years was 100% for plication, 96% +/- 4% for resuspension, and 93% +/- 7% for plication plus resuspension (p = 0.6); respective freedom from AI > or =3+ at 3 years was 100%, 92% +/- 8%, and 89% +/- 11% (p = 0.8).
  
  
  CONCLUSIONS
  Cusp plication or resuspension are efficient and durable techniques to correct cusp prolapse in the trileaflet AV. Plication is typically the first choice because of its ease of use and lower risk of overcorrection; however, free margin resuspension is useful in specific situations.
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. laurent.dekerchove@uclouvain.be
authors.forename: Laurent
authors.initials: L
authors.lastname: de Kerchove
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Alain
authors.initials: A
authors.lastname: Poncelet
authors.forename: Jean
authors.initials: J
authors.lastname: Rubay
authors.forename: Christine
authors.initials: C
authors.lastname: Watremez
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Gébrine
authors.initials: G
authors.lastname: El Khoury
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001023:Aortic Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors