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Original Articles: Adult Cardiac

Long-Term Results of the Leaflet Extension Technique in Aortic Regurgitation: Thirteen Years of Experience in a Single Center

^a Department of Thoracic and Cardiovascular Surgery, Seoul National University Borame Medical Center, Seoul, South Korea
^b Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea

Accepted for publication April 2, 2009.

^_* Address correspondence to Dr Ahn, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul, 110-744, Korea (Email: ahnhyuk{at}snu.ac.kr).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: We evaluated the effectiveness and durability of the leaflet extension technique for correction of aortic regurgitation (AR) and the long-term clinical results.

Methods: Between March 1995 and August 2004, 41 consecutive patients were included. The mean age was 32.2 ± 13.9 years. The causes of AR were rheumatic in 31 patients (75.5%), degenerative in 2 patients (4.9%), bicuspid aortic valve in 4 patients (9.8%), infective endocarditis in 1 patient (2.4%), and congenital in 3 patients (7.3%). Leaflet extensions were performed in three leaflets for 32 patients, two leaflets for 3 patients, and only one leaflet for 6 patients. The mean follow-up duration was 92.9 ± 48.4 months.

Results: There were no early deaths and 2 late deaths. One patient died of cancer and the other patient died of infective endocarditis. The cardiac-related mortality was 2.4% (1 of 41 patients). During a mean follow-up of 7 years, severe AR was detected in 1 patient and moderate AR in 6 patients (17.0%; 7 of 41 patients). The causes of recurrent AR were infective endocarditis in 3 patients, disease progression in 3 patients, and Behçet's diseases in 1 patient. We performed 6 reoperations (14.6%), 3 in patients owing to infective endocarditis, 2 in patients owing to disease progression, and 1 in a patient owing to the suture dehiscence associated with Behçet's disease. The cumulative survival was 92.6% at 13 years. Freedom from recurrent AR was 97.5% at 5 years, 81.7% at 10 years, and 68.1% at 13 years.

Conclusions: The long-term durability of the leaflet extension technique was acceptable. The reoperations increased with time, but pericardial leaflet dysfunction was not the cause.

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Invited Commentary

Sylvain Chauvaud
Ann. Thorac. Surg. 2009 88: 89. [Extract] [Full Text] [PDF]

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				S. Chauvaud Invited commentary. Ann. Thorac. Surg., July 1, 2009; 88(1): 89 - 89. [Full Text] [PDF]