Document Detail


Cusp prolapse repair in trileaflet aortic valves: free margin plication and free margin resuspension techniques.
MedLine Citation:
PMID:  19632393     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cusp prolapse management is important in aortic valve (AV) sparing and repair to achieve durable results. We analyzed the midterm outcomes of two different techniques for trileaflet AV prolapse repair. METHODS: Between 1996 and 2008, 376 patients underwent elective AV repair: 88 with trileaflet AV (23%) had cusp prolapse repair, plication technique was performed in 34 (39%), resuspension technique in 33 (37%) and plication plus resuspension in 21 (24%). One cusp was repaired in 55 (62%), 2 cusps in 18 (21%), and 3 cusps in 15 (17%). RESULTS: No hospital deaths occurred. Patients undergoing resuspension with or without plication had more preoperative aortic insufficiency (AI; p = 0.01) and multiple cusp prolapses (p = 0.01). During follow-up (median, 41 months), 4 deaths occurred and 2 were cardiac related. Overall survival at 5 years was 95% +/- 5%. Two patients needed AV reoperation because of recurrent AI or AI plus AV stenosis. Recurrent AI grade > or =3+ developed in 4 patients; 1 with moderate AV stenosis. Freedom from reoperation at 5 years was 100% for plication, 96% +/- 4% for resuspension, and 93% +/- 7% for plication plus resuspension (p = 0.6); respective freedom from AI > or =3+ at 3 years was 100%, 92% +/- 8%, and 89% +/- 11% (p = 0.8). CONCLUSIONS: Cusp plication or resuspension are efficient and durable techniques to correct cusp prolapse in the trileaflet AV. Plication is typically the first choice because of its ease of use and lower risk of overcorrection; however, free margin resuspension is useful in specific situations.
Authors:
Laurent de Kerchove; Munir Boodhwani; David Glineur; Alain Poncelet; Jean Rubay; Christine Watremez; Jean-Louis Vanoverschelde; Philippe Noirhomme; Gébrine El Khoury
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  88     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-27     Completed Date:  2009-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  455-61; discussion 461     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. laurent.dekerchove@uclouvain.be
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aortic Valve / surgery*
Aortic Valve Insufficiency / etiology,  physiopathology,  surgery
Aortic Valve Prolapse / complications,  mortality,  surgery*,  ultrasonography
Cardiac Surgical Procedures / methods*
Echocardiography, Transesophageal
Female
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Recurrence
Reoperation
Risk Factors

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


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