Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material
| Autor: | Mustafa Cikirikcioglu, Patrick Olivier Myers, Yacine Aggoun, Cecile Tissot, Jan T. Christenson, Afksendiyos Kalangos |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Aortic valve
Male Time Factors Tissue Fixation medicine.medical_treatment Kaplan-Meier Estimate Heart Valve Prosthesis Implantation/adverse effects/instrumentation/mortality Ventricular Function Left Aortic valve repair Risk Factors Mitral valve Pericardium Child Ultrasonography Heart Valve Prosthesis Implantation ddc:617 Hazard ratio Pericardium/transplantation medicine.anatomical_structure Treatment Outcome Aortic Valve Heart Valve Prosthesis Cardiology cardiovascular system Female Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine Reoperation medicine.medical_specialty Adolescent Aortic Valve Insufficiency Rheumatic Heart Disease/mortality/physiopathology/ surgery/ultrasonography Aortic Valve Insufficiency/mortality/physiopathology/ surgery/ultrasonography Risk Assessment Transplantation Autologous Disease-Free Survival Fixatives Young Adult Internal medicine medicine Animals Humans cardiovascular diseases Proportional Hazards Models Retrospective Studies Bioprosthesis Mitral valve repair Chi-Square Distribution business.industry Rheumatic Heart Disease Recovery of Function Aortic Valve/physiopathology/ surgery/ultrasonography Surgery Transplantation Glutaral Concomitant Cattle business |
| Zdroj: | Journal of Thoracic and Cardiovascular Surgery, Vol. 140, No 4 (2010) pp. 836-844 |
| ISSN: | 1097-685X 0022-5223 |
| Popis: | OBJECTIVE: Aortic valve repair has encouraging midterm results in selected patients. However, neither the long-term results of cusp extension nor the durability of different pericardial fixation techniques has been reported. Our goal was to address these issues. METHODS: Seventy-eight children with severe rheumatic aortic regurgitation (mean age 12 +/- 3.5 years) underwent aortic valve repair using cusp extension over a 15-year period, with fresh autologous pericardium in 53 (67.9%), glutaraldehyde-fixed bovine pericardium in 9 (11.5%), and PhotoFix bovine pericardium (Sorin CarboMedics, Milano, Italy) in 16 (20.5%). Fifty-seven children (73.1%) underwent concomitant mitral valve repair, and 8 children (10.3%) underwent tricuspid valve repair. RESULTS: There was 1 operative death from left ventricular failure. During a median follow-up of 10.7 years (range 1 month to 16.4 years), 1 late death occurred and 15 patients (19.7%) required reoperation at a mean of 43 +/- 33.7 months (range 1 month to 9 years), 9 within the autologous pericardium group (18%), 3 within the bovine pericardium group (33%), and 3 within the PhotoFix pericardium group (19%). Freedom from reoperation was 96% +/- 2.3% at 1 year, 87.5% +/- 3.9% at 5 years, 80.7% +/- 4.9% at 10 years, and 75.3% +/- 6% at 15 years, and was significantly decreased in the bovine pericardium group (P = .039). On multivariable analysis, greater age (hazard ratio 1.25, P < .001) and acute rheumatic carditis (hazard ratio 8.15, P = .001) at operation were significant predictors of reoperation. CONCLUSIONS: Aortic cusp extension provides adequate valve repair in a large proportion of children with rheumatic aortic regurgitation. Fresh autologous and PhotoFix pericardium trended toward better durability than glutaraldehyde-fixed bovine pericardium. |
| Databáze: | OpenAIRE |
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