Aortic Valve-Sparing Repair with Autologous Pericardial Leaflet Extension Has Low Long-Term Mortality and Reoperation Rates in Children and Adults

Authors

  • Oved Cohen
  • David J. De La Zerda
  • Jonah Odim
  • Ivo Dinov
  • Hillel Laks

DOI:

https://doi.org/10.1532/HSF98.20071022

Abstract

Objectives. We sought to establish whether there was a difference in outcome after aortic valve repair with autologous pericardial leaflet extension in pediatric and adult populations.

Methods. In our study, 128 patients (pediatric and adult) underwent valvular pericardial extension repair at our institution from 1997 through 2006. The patients were divided into either the pediatric group (?18 years of age; n = 54/128, 42%), with a mean age of 8.4 ± 5.4 (range, 0-17 years), or the adult group (n = 74/128, 58%), with a mean age of 48.9 ± 19.7 (range, 19-85 years). The endpoints of the study were mortality and reoperation rates.

Results. Thirty-day mortality for the adult group was 0, and for the pediatric group it was 1/54 (1.8%), with no statistical difference (P = .1) between the groups. Late mortality for the pediatric group was 2/54 (3.7%) and in the adult group was 2/74 (2.7%). There was no statistical difference (P = .12) between the groups. In the pediatric group, there were 6 total reoperations (6/54) in 5 patients, with one patient undergoing reoperation twice. From these 6 cases, 3 were re-repair and 3 had aortic valve replacement; the mean interval between original repair and reoperation was 4.3 ± 2.5 years (range, 0.1-7.7 years). In the adult group, there were 5 total reoperations (5/74). From these 5 cases, 3 had aortic valve replacement and 2 re-repair; the mean interval between original repair and reoperation was 3.5 ± 3 years (range, 0.1-7 years). There was no statistical difference in the reoperation rate between the 2 groups (P= .38). At late follow-up, 82% of all patients in the adult group had no aortic regurgitation or only a trace (grades 0 and 1) and 78% of all patients in the pediatric group had no aortic regurgitation or only a trace (grades 0 and 1). There was no statistical difference in either aortic regurgitation (P = .06) or aortic stenosis (P = .28) between the 2 groups.

Conclusions. Aortic valve repair with autologous pericardial leaflet extension has low mortality and morbidity rates, as well as good mid-term durability in both the pediatric and the adult groups.

References

Bradley SM, Sade RM, Crawford FA. 1997. Anticoagulation in children with mechanical valve prostheses. Ann Thorac Surg64:30-6.nBozbuga N, Erentug V, Kirali K, Akinci E, Isik O, Yakut C. 2004. Midterm results of aortic valve repair with the pericardial cusp extension technique in rheumatic valve disease. Ann Thorac Surg77:1272-6.nDahm M, Lyman WD, Factor SM, Frater RW. 1990. Immunogenicity of glutaraldehyde-tanned bovine pericardium. J Thorac Cardiovasc Surg99:1082-90.nDuran CM, Alonso J, Gaite L, et al. 1988. Long term results of conservative repair of rheumatic aortic valve insufficiency. Eur J Cardiothorac Surg2:217-23.nDuran C, Gometza B, Kuma N, Gallo R, Bjonastad K. 1995. From aortic cusp extension to valve replacement with stentless pericardium. Ann Thorac Surg60:S428-32.nDuran CMG, Gometza B, Kuma N. 1995. Aortic valve replacement with freehand autologous pericardium. J Thorac Cardiovasc Surg110:511-6.nDuran C, Gometza B, Kuma N, Gallo R, Bjonastad K. 1995. Treated bovine and autologous pericardium: surgical technique. J Cardiac Surg10:1-9.nGrinda JM, Latremouille C, Berrebi A, et al. 2002. Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results. Ann Thorac Surg74:438-43.nHalees Z, Shahid M, Sanei A, Sallehudin, Duran C. 2005. Up to 16 years follow-up of aortic reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothorac Surg28:200-5.nDinov I. 2006. SOCR: Statistics Online Computational Resource: socr.ucla.edu, Statistical Computing & Graphics17:11-5.nOdim J, Laks H, Allada V, Child J, Wilson S, Gjertson D. 2005. Results of aortic valve sparing and restoration with autologous pericardial leaflet extension in congenital heart disease. Ann Thorac Surg80:647-54.nRobbins RC, Bowman FO, Malm JR. 1988. Cardiac valve replacement in children: a twenty-year series. Ann Thorac Surg45:56-61.nSade RM, Crawford FA, Fyfe DA, Ginn G. 1988. Valves prostheses in children: a reassessment of anticoagulation. J Thorac Cardiovasc Surg95:553-61.n

Published

2007-06-04

How to Cite

Cohen, O., De La Zerda, D. J., Odim, J., Dinov, I., & Laks, H. (2007). Aortic Valve-Sparing Repair with Autologous Pericardial Leaflet Extension Has Low Long-Term Mortality and Reoperation Rates in Children and Adults. The Heart Surgery Forum, 10(4), E288-E291. https://doi.org/10.1532/HSF98.20071022

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