title: Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material.
abstract: OBJECTIVE
  Aortic valve repair has encouraging midterm results in selected patients. However, neither the long-term results of cusp extension nor the durability of different pericardial fixation techniques has been reported. Our goal was to address these issues.
  
  
  METHODS
  Seventy-eight children with severe rheumatic aortic regurgitation (mean age 12 ± 3.5 years) underwent aortic valve repair using cusp extension over a 15-year period, with fresh autologous pericardium in 53 (67.9%), glutaraldehyde-fixed bovine pericardium in 9 (11.5%), and PhotoFix bovine pericardium (Sorin CarboMedics, Milano, Italy) in 16 (20.5%). Fifty-seven children (73.1%) underwent concomitant mitral valve repair, and 8 children (10.3%) underwent tricuspid valve repair.
  
  
  RESULTS
  There was 1 operative death from left ventricular failure. During a median follow-up of 10.7 years (range 1 month to 16.4 years), 1 late death occurred and 15 patients (19.7%) required reoperation at a mean of 43 ± 33.7 months (range 1 month to 9 years), 9 within the autologous pericardium group (18%), 3 within the bovine pericardium group (33%), and 3 within the PhotoFix pericardium group (19%). Freedom from reoperation was 96% ± 2.3% at 1 year, 87.5% ± 3.9% at 5 years, 80.7% ± 4.9% at 10 years, and 75.3% ± 6% at 15 years, and was significantly decreased in the bovine pericardium group (P = .039). On multivariable analysis, greater age (hazard ratio 1.25, P < .001) and acute rheumatic carditis (hazard ratio 8.15, P = .001) at operation were significant predictors of reoperation.
  
  
  CONCLUSIONS
  Aortic cusp extension provides adequate valve repair in a large proportion of children with rheumatic aortic regurgitation. Fresh autologous and PhotoFix pericardium trended toward better durability than glutaraldehyde-fixed bovine pericardium.
authors.affiliation: Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland. patrick.myers@hcuge.ch
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.forename: Cécile
authors.initials: C
authors.lastname: Tissot
authors.forename: Jan T
authors.initials: JT
authors.lastname: Christenson
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cikirikcioglu
authors.forename: Yacine
authors.initials: Y
authors.lastname: Aggoun
authors.forename: Afksendiyos
authors.initials: A
authors.lastname: Kalangos
mesh_terms: D000293:Adolescent; D000818:Animals; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D002417:Cattle; D016009:Chi-Square Distribution; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005404:Fixatives; D005976:Glutaral; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010496:Pericardium / Q000637:transplantation; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016707:Tissue Fixation; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D005404:Fixatives; D005976:Glutaral