Universität zu Köln

Mazzitelli, Domenico, Stamm, Christof, Rankin, J. Scott, Pfeiffer, Steffen, Fischlein, Theodor, Pirk, Jan, Choi, Yeong-Hoon, Detter, Christian, Kroll, Johannes, Beyersdorf, Friedhelm ORCID: 0000-0003-2975-2751, Shrestha, Malakh, Schreiber, Christian and Lange, Ruediger (2014). Leaflet Reconstructive Techniques for Aortic Valve Repair. Ann. Thorac. Surg., 98 (6). S. 2053 - 2061. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1552-6259

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Abstract

Background. Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair. Methods. Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency (AI). The mean age was 63 +/- 13 years, and 69% of the patients were male. Ascending aortic/root replacement was required in 62%. As a first step, ring annuloplasty was performed, and then leaflet repair included leaflet plication for prolapse, nodular unfolding, double pericardial patching of commissural defects or holes, complete pericardial leaflet replacement, leaflet extension, and Gore-Tex reinforcement. Leaflet techniques and causes of adverse outcomes were evaluated. Results. The follow-up time was 2-years maximal and 0.9 years mean, with a survival of 97%. Eighty percent of patients required repair of leaflet defects: leaflet prolapse (52/65-80%), ruptured commissures (6/65-9%), leaflet holes 4/65-6%), and nodular retraction (6/65-9%). The average preoperative AI grade of 2.9 +/- 0.8 fell to 0.7 +/- 0.7 (p < 0.0001). Three patients (4.6%) required interval valve replacement because of (1) suture untying, (2) iatrogenic leaflet tear, or (3) diphtheroid endocarditis. Five other patients experienced grade 2 or grade 3 AI: probable suture untying in 1 patient, ineffective leaflet extensions in 2 patients, and unsuccessful Gore-Tex reinforcements in 2 patients. Two patients with single pericardial leaflet replacements and all those with double pericardial reconstructions did well. Conclusions. Leaflet defects are common in patients with moderate to severe AI. Leaflet plication, nodular unfolding, and double pericardial patching performed well. Gore-Tex and leaflet extension seemed less satisfactory. Standardization and experience with leaflet reconstruction will be important for optimizing the outcomes of aortic valve repair. (C) 2014 by The Society of Thoracic Surgeons

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mazzitelli, Domenico UNSPECIFIED UNSPECIFIED UNSPECIFIED Stamm, Christof UNSPECIFIED UNSPECIFIED UNSPECIFIED Rankin, J. Scott UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfeiffer, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED Fischlein, Theodor UNSPECIFIED UNSPECIFIED UNSPECIFIED Pirk, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Choi, Yeong-Hoon UNSPECIFIED UNSPECIFIED UNSPECIFIED Detter, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kroll, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Beyersdorf, Friedhelm UNSPECIFIED orcid.org/0000-0003-2975-2751 UNSPECIFIED Shrestha, Malakh UNSPECIFIED UNSPECIFIED UNSPECIFIED Schreiber, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Lange, Ruediger UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-422351
DOI:	10.1016/j.athoracsur.2014.06.052
Journal or Publication Title:	Ann. Thorac. Surg.
Volume:	98
Number:	6
Page Range:	S. 2053 - 2061
Date:	2014
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1552-6259
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ANNULOPLASTY RING; ROOT SURGERY; REPLACEMENT; MODEL; GEOMETRY; OUTCOMES; DISEASE; RISK Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42235