title: Aortic valve reconstruction in myxomatous degeneration of aortic valves: are fenestrations a risk factor for repair failure?
abstract: OBJECTIVE
  Aortic valve repair is a more recent approach for the treatment of aortic regurgitation. Limited data exist for reconstruction in specific pathologies with isolated cusp pathology. We analyzed the results of aortic valve repair in patients with aortic regurgitation caused by myxomatous cusp prolapse in the presence of tricuspid valve anatomy and normal root size.
  
  
  METHODS
  Over a 12-year period, 111 patients underwent aortic valve reconstruction for regurgitant tricuspid aortic valves without concomitant root dilatation. Cusp prolapse was caused by myxomatous degeneration in 72 subjects (group I) and associated with fenestrations in 39 subjects (group II). Prolapse was corrected by means of plication of the free margin in the presence of normal cusp tissue only (n = 62) or combined with triangular resection of cusp tissue (n = 10). It was treated with additional closure of the fenestration with autologous pericardium in 39 instances (group II). Follow-up was complete in 98.5% (cumulative 385 years).
  
  
  RESULTS
  Hospital mortality was 1.8%, and during follow-up, there was 1 thromboembolic event and no endocarditis. Freedom from reoperation at 5 and 8 years was 96%.
  
  
  CONCLUSIONS
  Isolated cusp prolapse is a relevant cause of aortic regurgitation in tricuspid aortic valves without concomitant root dilatation. In myxomatous stretching of cusp tissue, plication of the free margin suffices to restore cusp geometry and aortic valve function. In the presence of fenestrations, reconstruction of normal cusp configuration can be achieved by means of closure of the fenestration with a pericardial patch. The midterm stability of both approaches is good.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, 66421 Homburg/Saar, Germany. h-j.schaefers@uniklinikum-saarland.de
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: Frank
authors.initials: F
authors.lastname: Langer
authors.forename: Petra
authors.initials: P
authors.lastname: Glombitza
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.forename: Roland
authors.initials: R
authors.lastname: Fries
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult