Leaflet reconstructive techniques for aortic valve repair
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Leaflet reconstructive techniques for aortic valve repair. / Mazzitelli, Domenico; Stamm, Christof; Rankin, J Scott; Pfeiffer, Steffen; Fischlein, Theodor; Pirk, Jan; Choi, Yeong-Hoon; Detter, Christian; Kroll, Johannes; Beyersdorf, Friedhelm; Shrestha, Malakh; Schreiber, Christian; Lange, Rüdiger.
In: ANN THORAC SURG, Vol. 98, No. 6, 12.2014, p. 2053-2060.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Leaflet reconstructive techniques for aortic valve repair
AU - Mazzitelli, Domenico
AU - Stamm, Christof
AU - Rankin, J Scott
AU - Pfeiffer, Steffen
AU - Fischlein, Theodor
AU - Pirk, Jan
AU - Choi, Yeong-Hoon
AU - Detter, Christian
AU - Kroll, Johannes
AU - Beyersdorf, Friedhelm
AU - Shrestha, Malakh
AU - Schreiber, Christian
AU - Lange, Rüdiger
N1 - Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2014/12
Y1 - 2014/12
N2 - BACKGROUND: Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair.METHODS: Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency (AI). The mean age was 63 ± 13 years, and 69% of the patients were male. Ascending aortic/root replacement was required in 62%. As a first step, ring annuloplasty was performed, and then leaflet repair included leaflet plication for prolapse, nodular unfolding, double pericardial patching of commissural defects or holes, complete pericardial leaflet replacement, leaflet extension, and Gore-Tex reinforcement. Leaflet techniques and causes of adverse outcomes were evaluated.RESULTS: The follow-up time was 2-years maximal and 0.9 years mean, with a survival of 97%. Eighty percent of patients required repair of leaflet defects: leaflet prolapse (52/65-80%), ruptured commissures (6/65-9%), leaflet holes (4/65-6%), and nodular retraction (6/65-9%). The average preoperative AI grade of 2.9 ± 0.8 fell to 0.7 ± 0.7 (p < 0.0001). Three patients (4.6%) required interval valve replacement because of (1) suture untying, (2) iatrogenic leaflet tear, or (3) diphtheroid endocarditis. Five other patients experienced grade 2 or grade 3 AI: probable suture untying in 1 patient, ineffective leaflet extensions in 2 patients, and unsuccessful Gore-Tex reinforcements in 2 patients. Two patients with single pericardial leaflet replacements and all those with double pericardial reconstructions did well.CONCLUSIONS: Leaflet defects are common in patients with moderate to severe AI. Leaflet plication, nodular unfolding, and double pericardial patching performed well. Gore-Tex and leaflet extension seemed less satisfactory. Standardization and experience with leaflet reconstruction will be important for optimizing the outcomes of aortic valve repair.
AB - BACKGROUND: Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair.METHODS: Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency (AI). The mean age was 63 ± 13 years, and 69% of the patients were male. Ascending aortic/root replacement was required in 62%. As a first step, ring annuloplasty was performed, and then leaflet repair included leaflet plication for prolapse, nodular unfolding, double pericardial patching of commissural defects or holes, complete pericardial leaflet replacement, leaflet extension, and Gore-Tex reinforcement. Leaflet techniques and causes of adverse outcomes were evaluated.RESULTS: The follow-up time was 2-years maximal and 0.9 years mean, with a survival of 97%. Eighty percent of patients required repair of leaflet defects: leaflet prolapse (52/65-80%), ruptured commissures (6/65-9%), leaflet holes (4/65-6%), and nodular retraction (6/65-9%). The average preoperative AI grade of 2.9 ± 0.8 fell to 0.7 ± 0.7 (p < 0.0001). Three patients (4.6%) required interval valve replacement because of (1) suture untying, (2) iatrogenic leaflet tear, or (3) diphtheroid endocarditis. Five other patients experienced grade 2 or grade 3 AI: probable suture untying in 1 patient, ineffective leaflet extensions in 2 patients, and unsuccessful Gore-Tex reinforcements in 2 patients. Two patients with single pericardial leaflet replacements and all those with double pericardial reconstructions did well.CONCLUSIONS: Leaflet defects are common in patients with moderate to severe AI. Leaflet plication, nodular unfolding, and double pericardial patching performed well. Gore-Tex and leaflet extension seemed less satisfactory. Standardization and experience with leaflet reconstruction will be important for optimizing the outcomes of aortic valve repair.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve/surgery
KW - Aortic Valve Insufficiency/diagnostic imaging
KW - Cardiac Valve Annuloplasty/methods
KW - Echocardiography, Transesophageal
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Pericardium/transplantation
KW - Retrospective Studies
KW - Surgical Flaps
KW - Suture Techniques
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.athoracsur.2014.06.052
DO - 10.1016/j.athoracsur.2014.06.052
M3 - SCORING: Journal article
C2 - 25468084
VL - 98
SP - 2053
EP - 2060
JO - ANN THORAC SURG
JF - ANN THORAC SURG
SN - 0003-4975
IS - 6
ER -
