Midterm result of leaflet extension technique in aortic regurgitation

Our plain-English summary of Midterm result of leaflet extension technique in aortic regurgitation, by H. Ahn, K.H. Kim, Y.J. Kim (European Journal of Cardio-thoracic Surgery, 2002).

The study

• Authors: H. Ahn, K.H. Kim, Y.J. Kim
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2002;21(3):465-9
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: Aortic valve leaflet extension using glutaraldehyde-fixed autopericardium in aortic regurgitation (AR) is technically demanding, and it is not a popular procedure among surgeons. This study evaluates the effectiveness and clinical feasibility of the leaflet extension technique as a treatment modality for AR.

Materials And Methods: From March 1995 to March 2001, 34 consecutive patients underwent the leaflet extension technique. The mean age of the 26 men and eight women was 31.0+/-14.3 years (range 16-68). They were all diagnosed with pure aortic valve regurgitation, and nine (27.3%) had associated mitral valvular heart diseases. Accurate measurement of the leaflet free margins was performed with a pair of compasses before leaflet extension. Glutaraldehyde-fixed autopericardium was designed according to the free margin lengths. Leaflet extension was performed in three aortic leaflets for 29 patients but only one leaflet was extended in the remaining four. The nine patients with associated mitral valvular heart disease also underwent mitral valvuloplasty. Mean cardiopulmonary bypass time and ischemic time in 25 isolated AR group were 128.7+/-26.5min (range 70--180) and 101.5+/-25.5min (range 41-150), respectively.

Results: There was no incidence of in-hospital mortality. Immediate postoperative echocardiography revealed grade II AR in one, grade I AR in ten and no AR in the remaining 23 patients. Mean follow-up duration was 49.6+/-18.8 months (range 4.1-77.1). Echocardiographic AR grades during follow-up were grade II in 13, grade I in 11 and no AR in eight. The remaining two patients underwent reoperation, one aortic valve replacement because of subacute bacterial endocarditis that occurred 7 months after leaflet extension, and the other Ross operation because of the dehiscence of the valvuloplasty suture site that developed 4 months later (AR associated with Behcet's disease). There was one case of mortality due to malignant mesothelioma 4 years after aortic valvuloplasty. The cumulative survival rate was 94.1% at 5 years. Freedom from reoperation was 93.8% at 1 year and after.

Conclusions: The leaflet extension technique is an acceptable surgical treatment modality for AR and its clinical results were confirmed in this study to be very good. A careful long-term follow-up study will be necessary to evaluate the long-term durability of the glutaraldehyde-preserved autologous pericardium as a leaflet tissue.

In plain English

This article is a heart-surgery report, not a study of asbestos. Surgeons at Seoul National University Hospital in South Korea reviewed their experience with 34 patients (26 men and eight women, mean age 31.0 years). Between March 1995 and March 2001, each had a leaking aortic heart valve (aortic regurgitation) repaired by lengthening the valve leaflets with the patient's own heart-sac tissue (pericardium) treated with glutaraldehyde. Most cases were rheumatic in origin. No patient died in hospital. Two patients (5.9%) needed a second operation: one for fungal endocarditis and one for a partial breakdown of the repair's suture line. One patient died 4 years after the operation of malignant mesothelioma, and that patient showed no postoperative evidence of valve leakage. The article does not say where in the body the mesothelioma arose and does not mention asbestos. Cumulative survival at 5 years was 94.1%. The authors concluded the technique was an acceptable treatment with very good clinical results. They said longer follow-up is needed to judge how durable the treated tissue is.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of one hospital's consecutive surgical case series (no comparison group)
• Who was studied: 34 patients (26 male, 8 female, mean age 31.0 years, range 16 to 68) with pure aortic regurgitation who underwent leaflet extension, out of 373 aortic valve operations at Seoul National University Hospital, South Korea, March 1995 to March 2001
• Exposure: No asbestos exposure was studied or mentioned. The intervention studied was aortic valve leaflet extension using glutaraldehyde-fixed autologous pericardium; nine patients also had mitral valve repair.
• Main results:
  • No patient died in hospital.
  • Aortic regurgitation grade measured during surgery fell from a mean of 3.6 (plus or minus 0.6) before repair to 0.4 (plus or minus 0.4) after repair, P less than 0.01.
  • Over a mean follow-up of 49.6 months, two of the 34 patients (5.9%) needed reoperation for recurrent aortic regurgitation.
  • One patient died 4 years after the operation of malignant mesothelioma and had shown no postoperative aortic regurgitation. The article gives no site of the mesothelioma and no exposure history.
  • In the 32 patients with follow-up echocardiography, aortic regurgitation was grade 0 in eight, grade I in 11 and grade II in 13.
  • Cumulative survival at 5 years was 94.1% (plus or minus 5.7%). Freedom from reoperation was 93.8% (plus or minus 4.3%) at 1 year and after.
• The authors' conclusion: The authors concluded that leaflet extension for isolated aortic regurgitation was an acceptable surgical treatment and that its clinical results were very good.
• Limitations the authors state:
  • Follow-up was only midterm, so long-term structural and functional durability of the repaired valve could not be assessed.

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pericardium.

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