title: Outcomes of aortic valve repair according to valve morphology and surgical techniques.
abstract: OBJECTIVE
  The aim of this study was to assess the impact of aortic valve morphology and different surgical aortic valve repair techniques on long-term clinical outcomes.
  
  
  METHODS
  Between February 2003 and May 2010, 216 patients with aortic insufficiency underwent aortic valve repair in our institution. Ages ranged between 26 and 82 years (mean 53 ± 15 years). Aortic valve dysfunctions, according to functional classification, were: type I in 55 patients (25.5%), type II in 126 (58.3%) and type III in 35 (16.2%). Sixty-six patients (27.7%) had a bicuspid valve. Aortic valve repair techniques included sub-commissural plasty in 138 patients, plication in 84, free-edge reinforcement in 80, resection of raphe plus re-suturing in 40 and the chordae technique in 52. Concomitant surgical procedures were CABG in 22 (10%) patients, mitral valve repair in 12 (5.5%), aortic valve-sparing re-implantation in 78 (36%) and ascending aorta replacement in 69 (32%). Mean follow-up was 42 ± 16 months and was 100% complete.
  
  
  RESULTS
  There were six early deaths (2.7%). Overall late survival was 91.5% (18 late deaths). There were 15 (6.9%) late cardiac-related deaths. NYHA functional class was ≤ II in all patients. At follow-up, 28 (14.5%) patients had recurrent aortic insufficiency ≥ grade II. The freedom from valve-related events was significantly different between bicuspid and tricuspid valve implantation (P < 0.01), between type I + II and type III (P < 0.001) dysfunction and between the chordae technique and plication, compared to free-edge reinforcement (P < 0.01). Statistically-significant differences were found between patients who underwent aortic valve repair plus root re-implantation, compared to those who underwent isolated aortic valve repair (P = 0.02).
  
  
  CONCLUSIONS
  Aortic valve repair including aortic annulus stabilization is a safe surgical option with either tricuspid or bicuspid valves; even more so if associated with root re-implantation. Patients with calcified bicuspid valves have poor results.
authors: Department of Cardiac Surgery, University of Palermo, Palermo, Italy. khalilfattouch@hotmail.com
authors: Khalil
authors: K
authors: Fattouch
authors: Giacomo
authors: G
authors: Murana
authors: Sebastiano
authors: S
authors: Castrovinci
authors: Giuseppe
authors: G
authors: Nasso
authors: Claudia
authors: C
authors: Mossuto
authors: Egle
authors: E
authors: Corrado
authors: Giovanni
authors: G
authors: Ruvolo
authors: Giuseppe
authors: G
authors: Speziale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D002815:Chordae Tendineae / Q000601:surgery; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D016016:Proportional Hazards Models; D012008:Recurrence; D012092:Replantation; D018570:Risk Assessment; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography