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Valvular heart disease
Original research
Aortic valve repair techniques: an early UK experience
  1. Renata Greco1,
  2. Mirko Muretti1,
  3. Xu Yu Jin1 and
  4. Mario Petrou2
  1. 1Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
  2. 2Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  1. Correspondence to Mr Mario Petrou; M.Petrou{at}rbht.nhs.uk

Abstract

Objectives Retrospective review of early results with aortic valve repair (AVr) techniques.

Methods 61 consecutive patients underwent AVr surgery at our institutions between 2008 and 2018. 14 patients had a bicuspid aortic valve and 16 had a connective tissue disorder. In 48 patients, aortic regurgitation (AR) was secondary to an aortic root and/or ascending aneurysms, while in 13 it was due to primary cusp pathologies. 13 patients underwent isolated cusp repair, 19 sinotubular junction remodelling, 25 valve-sparing root replacement (VSRR) and 4 hemiroot replacement. Cusp repair techniques included: 18 free margin plication, 18 commissural re-suspensions, 3 raphe resections and 1 free-edge reinforcement. Subcommissural annuloplasty was performed in 25 patients (42%) with a dilated annulus (>28 mm).

Results 50 patients (82%) left the operating theatre with no AR, 8 with mild central and 3 with mild eccentric AR. In-hospital survival was 100%. Clinical follow-up was complete at 5.08±2.29 years and all patients were alive. Transthoracic echocardiographic follow-up was complete at 2.35±1.92 years and showed the presence of a moderate AR in 10 patients (18%) and severe AR in 2 patients (4%). One of these required re-do aortic valve replacement 6 years after VSRR. Freedom from re-operation at 8 years was 88.15%±1.51%.

Conclusion Good early results are achievable following AVr with acceptable medium-term outcomes. AVr surgery continues to evolve, and concentrating the experience in specialist centres in the UK is recommended.

  • Marfans
  • surgery-valve
  • aortic valve disease
  • aortic disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001107

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    Footnotes

    • Correction notice This article has been updated since first published. First author affiliation has been revised, third author's name has been corrected to 'Xu Yu Jin', and reference 3 has been updated.

    • Contributors RG contributed to acquisition and interpretation of data; statistics: drafting the paper and revising it critically; approval of the submitted version. MM contributed to research design, revising it critically; approval of the submitted version. XYJ helped in acquisition and analysis of data; revising it critically; approval of the submitted version. MP helped in research design and interpretation of data; drafting the paper and revising it critically; approval of the submitted version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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