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Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material

Tissot, Cecile
Christenson, Jan T.
Published in Journal of thoracic and cardiovascular surgery. 2010, vol. 140, no. 4, p. 836-844
Abstract 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.
Keywords AdolescentAnimalsAortic Valve/physiopathology/ surgery/ultrasonographyAortic Valve Insufficiency/mortality/physiopathology/ surgery/ultrasonographyBioprosthesisCattleChi-Square DistributionChildDisease-Free SurvivalFemaleFixativesGlutaralHeart Valve ProsthesisHeart Valve Prosthesis Implantation/adverse effects/instrumentation/mortalityHumansKaplan-Meier EstimateMalePericardium/transplantationProportional Hazards ModelsRecovery of FunctionReoperationRetrospective StudiesRheumatic Heart Disease/mortality/physiopathology/ surgery/ultrasonographyRisk AssessmentRisk FactorsTime FactorsTissue FixationTransplantation, AutologousTreatment OutcomeVentricular Function, LeftYoung Adult
PMID: 20659746
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Other version: http://www.sciencedirect.com/science/journal/00225223
Research groups Chirurgie cardio-vasculaire (105)
L'hypertension pulmonaire (pédiatrie) (228)
(ISO format)
MYERS, Patrick Olivier et al. Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material. In: Journal of thoracic and cardiovascular surgery, 2010, vol. 140, n° 4, p. 836-844. doi: 10.1016/j.jtcvs.2010.06.036 https://archive-ouverte.unige.ch/unige:21161

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Deposited on : 2012-05-23

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