Valve repair for aortic insufficiency: surgical classification and techniques

Haydar, Sam; He, Guo‐Wei; Hovaguimian, Hagop; McIrvin, David M.; King, Douglas H.; Starr, Albert

doi:10.1016/s1010-7940(96)01014-7

Cited by 105 publications

(86 citation statements)

References 26 publications

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“…6,11,14 The reason for this may be related to the fact that any repair procedure on the tricuspid valve with the complex interference of 3 coaptation lines is more difficult compared with a bileaflet (mitral) or bicuspid (aortic) valve. 1 For many years, there was uncertainty regarding the prognostic implications of a bicuspid aortic valve-the second most frequent cause of pure regurgitation-and we know by now that the bicuspid valve can function adequately into the seventh decade of life if it has not developed stenosis by the third or fourth decade. 31,32 Consequently, good results have been reported for reconstruction of bicuspid aortic valves by some groups.…”

Section: Discussionmentioning

confidence: 99%

“…Repair of a tricuspid valve with 3 coaptation lines is more difficult than the bileaflet mitral valve; in addition, different pathologies of aortic root and cusps may contribute to valve dysfunction. [1][2][3][4] Dilatation of the aortic root is currently the most frequent cause of regurgitation. [2][3][4] Prolapse of cusp tissue in bicuspid anatomy or "floppy" tricuspid aortic valves 4 impairs coaptation by a different mechanism, especially in the presence of congenital fenestrations.…”

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confidence: 99%

“…Fenestrations or perforations can be closed with autologous pericardial patches. 1,11 So far, these approaches have been applied only in very selected groups of patients with aortic regurgitation. In many patients, however, AR is caused by a combination of both root and cusp pathology.…”

mentioning

confidence: 99%

“…Root ectasia involving the aorto-ventricular (AV) junction was addressed with reimplantation of the aortic valve within a vascular graft. 8 Cusp prolapse was corrected whenever relevant using plication of the free margin or triangular resec-tion, 1,6,14 cusp defects were corrected using autologous pericardium. 11 Repair was undertaken regardless of tricuspid or bicuspid aortic valve anatomy.…”

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confidence: 99%

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Aortic Valve Repair Using a Differentiated Surgical Strategy

Langer¹,

Aicher²,

Kissinger³

et al. 2004

Circulation

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Background-Reconstruction of the aortic valve for aortic regurgitation (AR) remains challenging, in part because of not only cusp or root pathology but also a combination of both can be responsible for this valve dysfunction. We have systematically tailored the repair to the individual pathology of cusps and root. Methods-Between October 1995 and August 2003, aortic valve repair was performed in 282 of 493 patients undergoing surgery for AR and concomitant disease. Root dilatation was corrected by subcommissural plication (nϭ59), supracommissural aortic replacement (nϭ27), root remodeling (nϭ175), or valve reimplantation within a graft (nϭ24). Cusp prolapse was corrected by plication of the free margin (nϭ157) or triangular resection (n ϭ36), cusp defects were closed with a pericardial patch (nϭ16). Additional procedures were arch replacement (nϭ114), coronary artery bypass graft (nϭ60) or mitral repair (nϭ24). All patients were followed-up (follow-up 99.6% complete), and cumulative follow-up was 8425 patient-months (mean, 33Ϯ27 months). Results-Eleven patients died in hospital (3.9%). Nine patients underwent reoperation for recurrent AR (3.3%). Actuarial freedom from AR grade ՆII at 5 years was 81% for isolated valve repair, 84% for isolated root replacement, and 94% for combination of both; actuarial freedom from reoperation at 5 years was 93%, 95%, and 98%, respectively. No thromboembolic events occurred, and there was 1 episode of endocarditis 4.5 years postoperatively. Conclusions-Aortic valve repair is feasible even for complex mechanisms of AR with a systematic and individually tailored approach. Operative mortality is low and mid-term durability is encouraging.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Aortic Valve Repair Using a Differentiated Surgical Strategy

Langer¹,

Aicher²,

Kissinger³

et al. 2004

Circulation

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“…[3][4][5][6][7] Valvepreserving operations, as described by Yacoub et al 4 and David et al, 5,6 have been used successfully in patients with aortic regurgitation caused by diseases of the aortic root whenever the aortic leaflets were normal or nearly normal. The presence of additional cusp disease is a frequent cause of immediate failure in these operations and therefore is often considered a contraindication for this surgery.…”

mentioning

confidence: 99%

Repair of Bicuspid Aortic Valves in Patients With Aortic Regurgitation

et al. 2006

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Background-Bicuspid aortic valve regurgitation can be caused by a defect in the valve itself or by dysfunction of one or more components of the aortic root complex. A successful repair thus requires correction of all aspects of the problem simultaneously. We review our experience addressing both the valve and the aortic root when correcting bicuspid valve regurgitation. Methods and Results-Between 1996 and 2004, we treated 68 patients for aortic regurgitation. Thirty patients had isolated aortic regurgitation, and 38 had an associated ascending aortic aneurysm. All patients were treated using a standardized and integrated surgical technique, which included resection of the median raphe or leaflet plication, subcommissural annuloplasty, reinforcement of the leaflet free edge, and sinotubular junction plication. In the 38 patients with proximal aortic dilatation, reimplantation or remodeling of the aortic root was performed. Immediate postoperative echocardiography showed grade Յ1 aortic regurgitation in all patients. Three patients nonetheless needed an early re-operation because of recurrent regurgitation. No hospital mortality was observed. At a mean follow-up of 34 months after surgery, all patients were in New York Heart Association (NYHA) class 1 or 2. Two patients needed a re-operation (23 and 92 months, respectively). Echocardiographic follow-up showed no progression of the regurgitation in 58 surviving patients. Four patients progressed to grade 2 regurgitation. Conclusion-Our data indicate that regurgitant bicuspid aortic valves, whether alone or in association with a proximal aortic dilatation, can be repaired successfully provided that both the valve and the aortic root problems are treated simultaneously.

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Left Ventricular Outflow Tract Obstruction

DeCampli

Pourmoghadam

2023

Pediatric Cardiac Surgery

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Valve repair for aortic insufficiency: surgical classification and techniques

Cited by 105 publications

References 26 publications

Aortic Valve Repair Using a Differentiated Surgical Strategy

Aortic Valve Repair Using a Differentiated Surgical Strategy

Repair of Bicuspid Aortic Valves in Patients With Aortic Regurgitation

Left Ventricular Outflow Tract Obstruction

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