Document Detail


Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material.
MedLine Citation:
PMID:  20659746     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Patrick O Myers; Cécile Tissot; Jan T Christenson; Mustafa Cikirikcioglu; Yacine Aggoun; Afksendiyos Kalangos
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Publication Detail:
Type:  Journal Article     Date:  2010-07-24
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-20     Completed Date:  2010-10-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  836-44     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland. patrick.myers@hcuge.ch
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Animals
Aortic Valve / physiopathology,  surgery*,  ultrasonography
Aortic Valve Insufficiency / mortality,  physiopathology,  surgery*,  ultrasonography
Bioprosthesis
Cattle
Chi-Square Distribution
Child
Disease-Free Survival
Female
Fixatives
Glutaral
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation* / adverse effects,  instrumentation,  mortality
Humans
Kaplan-Meiers Estimate
Male
Pericardium / transplantation
Proportional Hazards Models
Recovery of Function
Reoperation
Retrospective Studies
Rheumatic Heart Disease / mortality,  physiopathology,  surgery*,  ultrasonography
Risk Assessment
Risk Factors
Time Factors
Tissue Fixation
Transplantation, Autologous
Treatment Outcome
Ventricular Function, Left
Young Adult
Chemical
Reg. No./Substance:
0/Fixatives; 111-30-8/Glutaral

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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