Document Detail


Truly stentless autologous pericardial aortic valve replacement: an alternative to standard aortic valve replacement.
MedLine Citation:
PMID:  20965520     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of this study was to determine the feasibility and durability of truly stentless aortic valve replacement using autologous pericardium sutured directly onto the aortic wall.
METHODS: Eleven patients (mean age, 55.9 years) requiring aortic valve replacement were recruited. A circular piece of pericardium about 8 cm in diameter was harvested and treated in 0.6% glutaraldehyde for 10 minutes. The aortic valve was excised and, with the use of specially designed instruments (CardioMend LLC, Santa Barbara, Calif), the sinotubular junction was sized and the pericardium was tailored to the required size and shape and then sutured directly onto the aortic wall. The reconstructed valve was assessed directly and by echocardiography at the end of the operation; it was assessed by echocardiography and cardiac magnetic resonance imaging at 6 months and yearly. Computed tomographic scan of the aortic valve to assess for valve calcification was performed at last follow-up.
RESULTS: Hospital mortality was 0%. Mean follow-up was 6.5 years (range, 5.3-7.5 years). Freedom from structural valve deterioration, thromboembolism, endocarditis and reoperation was 100%, 100%, 72.7%, and 63.6%, respectively. There were 4 reoperations at 4, 13, 15, and 46 months, 3 of them owing to endocarditis and 1 owing to technical failure noted at the time of surgery. The remaining 7 patients are alive and well with a mean New York Heart Association class of 1.3 and normally functioning aortic valves with no calcification.
CONCLUSIONS: Truly stentless aortic valve replacement using autologous pericardium sutured directly onto the aortic wall is safe and feasible and has excellent durability up to 7.5 years with no calcification.
Authors:
K M John Chan; Shelley Rahman-Haley; Tarun K Mittal; Jemyrr A Gavino; Gilles D Dreyfus
Publication Detail:
Type:  Journal Article     Date:  2010-10-20
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-20     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  276-83     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. All rights reserved.
Affiliation:
Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom. KMJChan@btopenworld.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aorta / surgery
Aortic Valve / radiography,  surgery*,  ultrasonography
Aortic Valve Insufficiency / diagnosis,  ultrasonography*
Aortic Valve Stenosis / diagnosis,  surgery*
Bioprosthesis*
Calcinosis / diagnosis,  etiology
England
Feasibility Studies
Female
Glutaral
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  instrumentation*
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Pericardium / transplantation*
Pilot Projects
Prospective Studies
Prosthesis Design
Reoperation
Suture Techniques
Time Factors
Tissue Fixation / methods
Tissue and Organ Harvesting / methods
Tomography, X-Ray Computed
Transplantation, Autologous
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
111-30-8/Glutaral

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


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