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Original Articles: Adult Cardiac

Invited Commentary

Departement de Chirurgie Cardio-Vasculaire, Hôpital Européen Georges Pompidou, Service de Chirurgie Cardio-vasculaire, 20-40, rue Leblanc, Paris Cedex 15, 75908, France

(Email: sylvain.chauvaud{at}egp.ap-hop-paris.fr).

Conservative interventions for aortic valve incompetence are still controversial. In their study, Jeong and colleagues [1] emphasized the benefit of leaflet extension with autologous pericardium. The technique of leaflet extension was published many years ago and provides excellent short-term hemodynamic results.

The mean age of the cohort in their study was 32 years, and 71% had aortic valve incompetence due to rheumatic disease. The leaflet extension technique is useful in this population setting, thus avoiding mechanical or biologic valve replacement with its drawbacks. The Ross procedure is not recommended in rheumatic disease.

The leaflet extension technique with autologous pericardium raises two important questions: the fate of the pericardium and the subsequent reoperation rate for failure of the reconstructive procedure.

The use of autologous pericardium in mitral valve repair is considered an acceptable technique [2]. Calcification appears between 5 to 10 years after patch implantation when used on the posterior leaflet. In time, posterior leaflet loss of pliability does not induce mitral valve insufficiency if coaptation of the anterior and posterior leaflets is maintained.

The mechanism of aortic leaflet closure is very different, and any shrinkage or stiffness of the patch could be at the origin of a central leak. This phenomenon increases the risk of reoperation.

The Jeong article reports 6 patients aged older than 41 years who underwent reoperations for rheumatic disease evolution and a high rate of endocarditis. From these results, one can think that the use of biologic prosthesis offers similar advantages and probably the same risks of reoperation in a young adult population.

This brings me to a word of caution concerning the technique of aortic leaflet extension with autologous pericardium. This procedure could be very useful in young patients with rheumatic disease, providing the possibility to delay valve replacement, especially when the mitral valve is also involved. It is probably the best choice, keeping in mind that a second operation will be necessary, at least in young patients.

	References

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1. Jeong DS, Kim K-H, Ahn H. Long-term results of the leaflet extension technique in aortic regurgitation: thirteen years of experience in a single center Ann Thorac Surg 2009;88:83-89.[Abstract/Free Full Text]
2. Chauvaud S, Jebara V. Valve extension with glutaraldehyde-preserved autologous pericardium: results in mitral valve repair J Thorac Cardiovasc Surg 1991;102:171-178.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chauvaud, S. Search for Related Content PubMed PubMed Citation Articles by Chauvaud, S. Related Collections Valve disease