Aortic cusp extension valvuloplasty for XXXX : midterm results.

@entity1 @entity339 @entity3584 @entity886 @entity337 @entity2333 @entity340
BACKGROUND: The surgical management of @entity337 in the young remains problematic owing to the drawbacks of prosthetic valve replacement at this age. In young foreign @entity1 , for whom long-term anticoagulation therapy is unavailable, we have used a @entity3584 preserved autologous pericardium cusp extension technique to repair rheumatic @entity337 resulting from cusp retractions. METHODS: From September 1992 to December 2000, 89 consecutive @entity1 with a mean age of 16 +/- 5 years underwent triple pericardial aortic cusp extension valvuloplasty. Eighty @entity1 had pure @entity337 , 9 had mixed @entity2333 . Twenty-nine @entity1 (33%) had isolated @entity886 and 60 @entity1 (69%) had combined aortic and mitral @entity340 with significant @entity340 in 21 (24%). Aortic repair consisted of free edge aortic cusp extension using three rectangular strips of @entity3584 stabilized autologous pericardium. Twenty-nine @entity1 (33%) underwent an isolated aortic repair, 39 @entity1 (44%) underwent combined aortic and mitral procedures (34 mitral repairs, 3 mitral homografts, and 2 prosthesis replacements), and 21 @entity1 (23%) underwent a triple valve repair. RESULTS: The hospital mortality was 2.2%. Primary failure of the aortic repair requiring immediate reoperation occurred in 2 @entity1 . During follow-up (mean of 62 +/- 22 months) 1 @entity1 died and 7 underwent redo valvular surgery. At 5 years the actuarial survival rate was 96.4%, and 92.1% of the @entity1 were free from redo valvular surgery. At 7 years 90% of the @entity1 were free from @entity340 . Among the 76 @entity1 free from redo valvular surgery at follow-up, 6 had deterioration of the repair resulting in @entity339 . CONCLUSIONS: Our midterm results of @entity3584 stabilized autologous pericardial aortic cusp extension are encouraging and suggest that this technique should be considered as a viable alternative palliative procedure in a young rheumatic population, allowing for growth of the annulus and delaying to a less critical period the need for the lifelong anticoagulation therapy required for a prosthetic mechanical valve.
