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 Adult Cardiac Surgery Discussion Forum.