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The Annals of Thoracic Surgery, Vol 58, 386-390, Copyright © 1994 by The Society of Thoracic Surgeons
CD Fraser Jr, N Wang, RB Mee, BW Lytle, PM McCarthy, SK Sapp, ER Rosenkranz and DM Cosgrove 3rd
A technique for the repair of bicuspid aortic valves that includes
resection of the flail segment of the prolapsing leaflet, annuloplasty, and
resection of the raphe, when present, has been reported. To assess the
efficacy of this technique in the repair of insufficient bicuspid aortic
valves, the results in 72 consecutive patients were assessed. The mean age
of the patients was 39 +/- 11 years; 94% were male. Fifty- six patients
(78%) underwent isolated aortic valve repair, 9 (12.5%) underwent aortic
and mitral valve repair, and 7 (9.7%) had other associated procedures. All
patients underwent leaflet resection, including 35 (48%) at the raphe. The
mean aortic occlusion time was 39 +/- 12 minutes. There were no operative
deaths. The severity of aortic insufficiency, as assessed by Doppler
echocardiography (graded from 0 to 4) preoperatively and intraoperatively
and at late follow-up, was 3.6 +/- 0.6, 0.4 +/- 0.4, and 0.9 +/- 0.8,
respectively, with a p value of < 0.0001 for the latter two values
versus the preoperative one. There have been no postoperative deaths.
Patients did not receive anticoagulation treatment and there were no
strokes or episodes of endocarditis. Six patients have required
reoperation; 3 underwent repeat repair. The Kaplan-Meier freedom from
aortic valve reoperation probabilities at 12 and 24 months were 94% and
89.5%, respectively. We conclude that valvuloplasty for insufficient
bicuspid aortic valves is technically safe, is associated with a low
incidence of recurrent insufficiency, and has been associated with no other
valve-related complications.
ARTICLES
Repair of insufficient bicuspid aortic valves
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
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