Isolated Aortic Valve Cusp Reconstruction in the Adult Population: Long-Term Single-Center Experience

Background: To evaluate our institutional experience of isolated aortic valve cusp (AV) reconstruction for aortic regurgitation (AR). Primary end-points were survival, freedom from AV reoperation, and freedom from AV replacement.

Method: From 2002 to 2020, a total of 103 patients underwent elective AV cusp reconstruction. Ninety-three patients (90%) were male, mean age 59.4 ± 16.1 years. Patch-reconstruction was used to raphe repair (n = 25; 48%), cusp extension (n = 6; 11%), perforation repair (n = 2; 2%). Other AV reconstruction techniques consisted from leaflet shaving/plication (n = 83; 81%), commissural narrowing (Cabrol procedure) (n = 77; 75%), reinforcement of the cusp edge (n = 3; 3%), and commissurotomy (n = 5; 5%). Echocardiographic and clinical follow-up was 94% complete and mean follow-up (FU) was 6.6 ± 4.9 years (range: 0–18.4 years).

Results: The 30-day mortality was 0.8% (1/103). Major morbidity included rethoracotomy for bleeding 6% (n = 6), pericardial effusion 3% (n = 3), and transient ischemic attack 1% (n = 1). There were six late deaths. All were noncardiac related. Overall, 5- and 10-year survival rates were 97 and 93%. The rates of freedom from AV reoperation and AV replacement at 5 and 10 years were 98% and 95% and 93% and 91%, respectively. Late AV reoperation was necessary in eight patients (8%) for recurrent AR (n = 6), AV stenosis (n = 1), or endocarditis (n = 1). At last FU echocardiography, 21 patients (24%) showed AR grade 0, 68 patients (76%) showed AR grade I, and no AR ≥ II. Mean transvalvular gradient at last FU was 11 ± 6 mm Hg. During follow-up, there was no occurrence of AV-related complications (endocarditis, thromboembolism, stroke, or bleeding).

Conclusion: Isolated AV cusp reconstruction in the adult population leads to normal long-term survival and excellent duration with a minimum of AV-related reoperations.

Publication History

Article published online:
03 February 2022