Aortic valve repair by cusp extension with the use of fresh autologous pericardium in children with rheumatic aortic insufficiency

Abstract

Functional results of aortic valve repair with cusp extension using fresh pericardium have been satisfactory at medium term, particularly in children with a small aortic anulus at the time of initial repair, because the expansion potential of fresh autologous pericardium is equivalent to that of the growing sinotubular junction and aortic anulus diameters.

Preliminary experience in the use of an extracellular matrix to repair congenital heart diseases

“…Kalangos et al [3] described good mid-term results in aortic valve repair with fresh autologous pericardium. Nevertheless, untreated autologous pericardium might have possess true growth but rather distensibility [4].…”

The Ross procedure in children: preoperative haemodynamic manifestation has significant effect on late autograft re-operation☆

“…While the incidence of rheumatic valve disease has significantly decreased in the Western world, it remains a major cause of aortic valvulopathy in developing countries [2]. Several developments in interventional cardiology allowed early treatment of congenital aortic stenosis, while recent experience with aortic valve-repair techniques shows encouraging short-and mid-term results in both congenital and rheumatic valve disease [3,4]. Nonetheless, in patients with significant valve destruction and following repair or intervention failure, aortic valve replacement is required.…”

Reconstructive surgery of the aortic valve

“…In the second group, a series of procedures whose greatest justification is to permit adequate coaptation of the three cuspids to distribute the forces and dissipate stress. Among these, the following can be utilized: a) commissural [18,19] and circumferential annuloplasty [10]; b) enlargement of the cuspids: increasing the free edge [11,[20][21][22][23][24] or inserting a graft between the annulus and the base of the cuspid [12,13,15]; c) cuspid replacement [25][26][27]; d) suspension of the cuspid by commissural plication [28,29]; triangular resection [10,14] or remodeling of the Valsalva sinus **. Figures 1 and 2 illustrate some of these procedures.…”

“…For the enlargement or substitution of the cuspids, several types of materials have been used, starting with ivalon sponge utilized by LILLEHEI in 1958 [20], fresh [21,22,24,25] or preserved bovine pericardium [27,31,32], heterologous pericardium treated with glutaraldehyde [11-13, 15, 26] and homographs [33].…”

“…Although the follow-up time of the patients submitted to aortic valve reconstructive surgery, in the majority of the published cohorts, is still short, the results until now are encouraging [14,15,24,27,34,[35][36][37]. Data from this work, a hospital mortality rate of 2.2% and probability of remaining reoperation-free of 81.3 ± 3.8 at five years and 59.8 ± 9.5 at ten years, are in harmony with the literature and help to consolidate the expectations in relation to aortic valve reconstructive surgery.…”