Aortic Leaflets Remodeling for Aortic Insufficiency: an Excellent Alternative to Replacement. Single Center Experience

#AC/VAL 01-O-3
Adult Cardiac Surgery/Valves. SESSION-1
Oral

Aortic Leaflets Remodeling for Aortic Insufficiency: an Excellent Alternative to Replacement. Single Center Experience

Mauro Masat¹, Giovanni Biagio Calcara¹, Antonio Pantaleo¹, Wadih Tamari¹, Valeria Salandin², Annamaria Camata², Luigi Polesello², Federica Mondin³, Marta Possamai³, Elvio Polesel¹

¹Department of Cardiovascular Surgery, Regional Hospital, Treviso, Italy; ²Department of Anesthesia, Regional Hospital, Treviso, Italy; ³Department of Cardiology, Regional Hospital, Treviso, Italy;

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–B

Abstract

Objectives : Aortic valve repair is considered to be a valid alternative to replacement in patients with aortic regurgitation. Recent data in the literature report excellent ten years results mainly for patients with aortic root dilatation and anatomically normal aortic valve. No data are up-to-date available about the results of the repair in patients with degenerative aortic valve (prolapse, thickness, perforation and/or retraction of the leaflets, congenital malformations). We analyzed retrospectively our data.

Methods : From January 2011 to November 2017, 90 patients with degenerative aortic valve insufficiency (IA) were treated with sugical remodelling of the aortic leaflets. The failure mechanism responsible conditioned the choice of technique (shaving, correction of prolapse, raphe excision, use of pericardium, commissural re-orientation). All patients were submitted to pre and postoperative transoesophageal echocardiography and followed up with transthoracic echocardiography and clinical monitoring.

Results : No in-hospital mortality was reported, two late deaths (2,22%) were due to non cardiac cause. Three patiens (3,33%) needed post-repair intraoperative aortic valve replacement, two (2,22%) during the follow-up. The incidence of postoperative complication was low: 2 (2,22%) transient low output syndrome, 3 (3,33%) postoperative bleeding, 1 (1,11%) transient neurological deficit, 1 (1,11%) temporary renal failure, 3 (3,33%) acute myocardial ischemia, 1 (1,11%) implantation of definitive pace-maker. No thromboembolic and haemorragic events was referred, as well as infectious endocarditis. Early or late recurrence of IA >2 was detected in 4 pts (4,44%).

Conclusions : Remodelling of the aortic valve leaflets represents an attractive and valid alternative to aortic valve replacement in patients with aortic valve insufficiency, mainly in young patients. In our experience the results are excellent in terms of short and middle term survival, postoperative complications and freedom from reoperation. More data are needed to extablish whether remodelling of the cusps is better then valve replacement in terms of late results.