Aortic valve repair by cusp extension with the use of fresh autologous pericardium in children with rheumatic aortic insufficiency

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 118; no. 2; pp. 225 - 236
• Main Authors: Kalangos, Afksendiyos, Beghetti, Maurice, Baldovinos, Ary, Vala, Dominique, Bichel, Thierry, Mermillod, Bernadette, Murith, Nicolas, Oberhansli, Ingrid, Friedli, Beat, Faidutti, Bernard
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.08.1999; AATS/WTSA; Elsevier
• Subjects: Adolescent; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary Bypass; Child; Child, Preschool; Echocardiography, Doppler; Echocardiography, Transesophageal; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Male; Medical sciences; Pericardium - transplantation; Retrospective Studies; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - physiopathology; Rheumatic Heart Disease - surgery; Transplantation, Autologous; Treatment Outcome; Ventricular Function, Left; Human; Prognosis; Homograft; Cardiovascular disease; Pressure gradient; Aortic regurgitation; Pericardium; Infection; Plasty; Treatment; Cardiac valvular disease; Follow up study; Surgery; Streptococcal infection; Bacteriosis; Graft; Aortic valve; Rheumatic fever
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(99)70212-6

Objectives: Our goal was to evaluate the midterm results of aortic valve repair by a more sophisticated tailoring of cusp extension—taking into account the dimensions of the native aortic cusps—with the use of fresh autologous pericardium. Patients and methods: Forty-one children who had severe rheumatic aortic insufficiency (mean age 11.5 ± 2.7 years) underwent aortic valve repair by means of this cusp extension technique over a 5-year period. Twenty-four of them underwent concomitant mitral valve repair for associated rheumatic mitral valve disease. All children were then followed up by transthoracic echocardiography before discharge, at 3 and 6 months after the operation, and at yearly intervals thereafter. Results: Follow-up was complete in all patients and ranged from 3 months to 5 years (median 3 years). No operative and no early postoperative deaths occurred. Only 1 patient died, 9 months after the operation, of septicemia and multiple organ failure. Actuarial survival was 97% at 1 year and has remained unchanged at 3 years. On discharge, the degree of aortic insufficiency was grade 0 for 27 children and grade I for 14. Exacerbation of aortic insufficiency from grade I to grade II was observed in only 1 patient, and none of the children required reoperation for aortic insufficiency during the follow-up period. Mean peak systolic aortic valve gradients at discharge were lower than preoperative values ( P = .04), and no significant increase in the peak systolic transvalvular gradient was detected thereafter during the follow-up period. Mean left ventricular dimensions were significantly reduced at discharge when compared with preoperative values ( P < .0001). Conclusions: Functional results of aortic valve repair with cusp extension using fresh pericardium have been satisfactory at medium term, particularly in children with a small aortic anulus at the time of initial repair, because the expansion potential of fresh autologous pericardium is equivalent to that of the growing sinotubular junction and aortic anulus diameters. (J Thorac Cardiovasc Surg 1999;118:225-36)