Posts:
104
Registered:
9/23/08
|
|
|
|
ATS July 2009: Long term results of leaflet extension technique in...
Posted:
Jul 6, 2009 9:39 AM
|
|
[nobr]ATS July 2009: Jeong SJ et al. Long term results of leaflet extension technique in aortic regurgitation: thirteen years of experience in a single center. Ann Thor Surg, 2009; 88:83-89.
In the July Annals, Dr. Dong Seop Jeong and colleagues from Seoul National University, South Korea, examine their results with aortic valve repair using leaflet extension with pericardium. The technique is nicely illustrated in the paper. Between 1995 and 2004, 41 patients with aortic insufficiency were included (mean age 32.2 years). The AI was rheumatic in 75.5%, degenerative in 4.9%, bicuspid aortic valve in 9.8%, infective endocarditis in 2.4%, and congenital in 7.3%. 28 Leaflet extensions were performed in three leaflets for 29 patients, two leaflets for 3 patients, and only one leaflet for 6 patients. The mean follow-up duration was 92.9 +/- 48.4 months.
There were no early deaths and there were 2 late deaths (one valve related). During a mean follow-up of 7 years, important AI was seen in 7 of 41 patients. The causes of recurrent AI were endocarditis (3), disease progression in (3), and Behçet’s disease (1). There were 6 reoperations, 3 due to endocarditis, 2 for disease progression, and 1 for suture dehiscence associated with Behçet’s disease. Cumulative survival was 92.6% at 13 years. Freedom from recurrent AI was 97.5% at 5 years, 81.7% at 10 years, and 68.1% at 13 years. The authors concluded that long-term durability of the leaflet extension technique was acceptable. The reoperations increased with time, but pericardial leaflet dysfunction was not the cause.
The results reported herein seem competitive with valve replacement when patient characteristics are taken into account. Yet, this technique (which has been available for several decades) has not met with overwhelming acceptance world wide. Please read the article at http://ats.ctsnetjournals.org/cgi/content/full/88/1/83 and add your comments (and experience) in the Annals Dilemmas in Pediatric Cardiac Surgery Discussion Forum. [/nobr]
|
|
Posts:
5
Registered:
6/13/09
|
|
|
|
Re: ATS July 2009: Long term results of leaflet extension technique in...
Posted:
Jul 17, 2009 8:25 AM
in response to: Tom Karl
|
|
Leaflet extension technique seems more adoptable when compared to the freehand autologous pericardial (Duran) or the stentless pericardial monopatch reconstruction of the aortic valve(Batista). Preservation of the natural hinge mechanism, as cited, is an added advantage with this technique.
While performing aortic valve repair, the net leaflet height, free length of the cusp and the effective height of the reconstructed aortic valve have to be appropriate in order to achieve good repair. An effective aortic valve height of 8 mm or more (adult patients) has been found to help in achieving good valve configuration and competence.
The other major issue involved, is the difficulty in testing the repaired aortic valve before the cross clamp is released. The 'simple' techniques recommended are cumbersome, unlike testing of the mitral valve. This makes it difficult to assess the repair and to refine the repair to achieve better competence. Perhaps, evolving easier methods of assessment of repair will lead to greater acceptance of aortic valve repair.
|
|
|
|
