Irem Karliova1, Ulrich Schneider2, Tristan Ehrlich1, Hans-Joachim Schäfers1. 1. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany. 2. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany. Electronic address: ulrich.schneider@uks.eu.
Abstract
BACKGROUND: Aortic valve repair for aortic regurgitation has become an increasingly accepted alternative to replacement. Some cusp pathologies require partial cusp replacement or augmentation using pericardium. There are limited data on pericardial patch durability. We analyzed our long-term results with pericardial patches in aortic cusp repair to clarify whether durability is influenced by aortic valve morphology or underlying cusp pathology. METHODS: From 2000 to 2017, 275 patients (mean age, 53 ± 14 years) underwent aortic valve repair involving pericardial patches with tricuspid aortic valve (n = 139, 50.5%) or bicuspid aortic valve (n = 136, 49.5%) morphology. Pericardial patches were used for either central cusp replacement (n = 64, 23%), closure of defects (n = 55, 20%), fenestrations (n = 104, 38%), cusp augmentation (n = 27, 10%), or commissural reconstruction (n = 25, 9%). Follow-up was complete in 96%. RESULTS: Ten-year survival was 85%, and 10-year freedom from reoperation was 53%. Durability was inferior after bicuspid aortic valve repair (37%) compared with tricuspid aortic valve repair (69%; P < .0001). Best 10-year freedom from reoperation was found after closure of fenestrations (73%) and defects (67%). Suboptimal durability was observed after cusp augmentation (44%), central cusp replacement (39%), and commissural reconstruction (16%, P < .001). CONCLUSIONS: The results of aortic cusp repair using pericardium depend on valve morphology and cusp pathology. Mid- and long-term durability is reasonable in tricuspid aortic valve repair. In bicuspid aortic valve repair valve stability is poor regardless of cusp pathology and repair technique. For any analysis of patch durability, details of pathology and technique have to be considered.
BACKGROUND: Aortic valve repair for aortic regurgitation has become an increasingly accepted alternative to replacement. Some cusp pathologies require partial cusp replacement or augmentation using pericardium. There are limited data on pericardial patch durability. We analyzed our long-term results with pericardial patches in aortic cusp repair to clarify whether durability is influenced by aortic valve morphology or underlying cusp pathology. METHODS: From 2000 to 2017, 275 patients (mean age, 53 ± 14 years) underwent aortic valve repair involving pericardial patches with tricuspid aortic valve (n = 139, 50.5%) or bicuspid aortic valve (n = 136, 49.5%) morphology. Pericardial patches were used for either central cusp replacement (n = 64, 23%), closure of defects (n = 55, 20%), fenestrations (n = 104, 38%), cusp augmentation (n = 27, 10%), or commissural reconstruction (n = 25, 9%). Follow-up was complete in 96%. RESULTS: Ten-year survival was 85%, and 10-year freedom from reoperation was 53%. Durability was inferior after bicuspid aortic valve repair (37%) compared with tricuspid aortic valve repair (69%; P < .0001). Best 10-year freedom from reoperation was found after closure of fenestrations (73%) and defects (67%). Suboptimal durability was observed after cusp augmentation (44%), central cusp replacement (39%), and commissural reconstruction (16%, P < .001). CONCLUSIONS: The results of aortic cusp repair using pericardium depend on valve morphology and cusp pathology. Mid- and long-term durability is reasonable in tricuspid aortic valve repair. In bicuspid aortic valve repair valve stability is poor regardless of cusp pathology and repair technique. For any analysis of patch durability, details of pathology and technique have to be considered.
Authors: J Scott Rankin; Domenico Mazzitelli; Theodor J M Fischlein; Yeong-Hoon Choi; Diana Aicher; Lawrence M Wei; Vinay Badhwar Journal: JTCVS Tech Date: 2020-01-23