|Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material.|
|PMID: 20659746 Owner: NLM Status: MEDLINE|
|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.|
|Patrick O Myers; Cécile Tissot; Jan T Christenson; Mustafa Cikirikcioglu; Yacine Aggoun; Afksendiyos Kalangos|
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|Type: Journal Article Date: 2010-07-24|
|Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Oct|
|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|
|Languages: eng Pagination: 836-44 Citation Subset: AIM; IM|
|Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.|
|Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland. email@example.com|
|APA/MLA Format Download EndNote Download BibTex|
Aortic Valve / physiopathology, surgery*, ultrasonography
Aortic Valve Insufficiency / mortality, physiopathology, surgery*, ultrasonography
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation* / adverse effects, instrumentation, mortality
Pericardium / transplantation
Proportional Hazards Models
Recovery of Function
Rheumatic Heart Disease / mortality, physiopathology, surgery*, ultrasonography
Ventricular Function, Left
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