Objectives: Aortic cusp prolapse (CP) can be an isolated cause of aortic regurgitation (AR) or component of a more complex mechanism associating aortic dilatation or bicuspid valve. The different techniques to correct aortic CP are central plication (PL), triangular resection (TR), cusp resuspension with Goretex suture (RS) and pericardial patch repair (PP). We analyze retrospectively the results of CP repair.
Methods: From 1996 to 2006, 298 patients underwent elective aortic valve (AV) repair. In 147 of them, prolapses of one (n=72) or more than one cusp (n=75) were repaired. Mean age was 50±16 years, 78 had bicuspid valve. One technique was used to correct the CP in 77 patients (PL=25,TR=12,RS=39,PP=1) and RS was associated to another technique in 70 (PL+RS=23,TR+RS=39,PP+RS=8). When indicated, shaving, subcommissural annuloplasty, sinotubular junction remodelling and AV sparing were performed.
Results: No hospital mortality. Five years overall survival was 99±1%. During follow-up (mean: 51±36months), 7 patients needed AV reoperation (2 re-repaired). Five years freedom from AV reoperation and AR >2 were 93±5% and 81±12% respectively. Considering those 2 endpoints, no difference was found between patients having one versus >one CP repair and significant difference was found for second endpoint between patients having one versus combined techniques of CP repair (87±12 vs 98±4%, p=0.1; 66±22% vs 94±12%, p=0.02).
Conclusions: In every AV repair, CP must be tracked and corrected to achieve an optimal level of coaptation. Durability of the repair seems to be more influenced by the aggressiveness of the repair than by the technique or the number of prolabing cusp.
Repair of Aortic Cusp Prolapse: Techniques and DurabilityLaurent de Kerchove, David Glineur, Michel van Dijck, Jean-Louis Vanoverschelde, Philippe Noirhomme, Gébrine el Khoury
Cliniques Universitaire Saint-Luc, Bruxelles |