Korean J Thorac Cardiovasc Surg.  2019 Feb;52(1):9-15. 10.5090/kjtcs.2019.52.1.9.

Long-Term Results of the Leaflet Extension Technique for Rheumatic Aortic Regurgitation: A 20-Year Follow-up

• Kwak YJ
• Ahn H
• Choi JW
• Kim KH

• KMID: 2452018
• DOI: http://doi.org/10.5090/kjtcs.2019.52.1.9

Abstract

BACKGROUND
Although aortic valve repair can reduce prosthesis-related complications, rheumatic aortic regurgitation (AR) caused by leaflet restriction is a significant risk factor for recurrent AR. In this study, we evaluated the long-term results of the leaflet extension technique for rheumatic AR.
METHODS
Between 1995 and 2016, 33 patients underwent aortic valve repair using the leaflet extension technique with autologous pericardium for rheumatic pure AR. Twenty patients had severe AR and 9 had combined moderate or greater mitral regurgitation. Their mean age was 32.2±13.9 years. The mean follow-up duration was 18.3±5.8 years.
RESULTS
There were no cases of operative mortality, but postoperative complications occurred in 5 patients. Overall survival at 10 and 20 years was 93.5% and 87.1%, respectively. There were no thromboembolic cerebrovascular events, but 4 late deaths occurred, as well as a bleeding event in 1 patient who was taking warfarin. Twelve patients underwent aortic valve reoperation. The mean interval to reoperation was 13.1±6.1 years. Freedom from reoperation at 10 and 20 years was 96.7% and 66.6%, respectively.
CONCLUSION
The long-term results of the leaflet extension technique showed acceptable durability and a low incidence of thromboembolic events and bleeding. The leaflet extension technique may be a good option for young patients with rheumatic AR.

Keyword

Leaflet extension; Aortic valve, regurgitation; Rheumatic diseases

MeSH Terms

Aortic Valve
Aortic Valve Insufficiency*
Follow-Up Studies*
Freedom
Hemorrhage
Humans
Incidence
Mitral Valve Insufficiency
Mortality
Pericardium
Postoperative Complications
Reoperation
Rheumatic Diseases
Risk Factors
Warfarin
Warfarin