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PubMed2001

Combined mitral valve and coronary artery surgery: ischemic versus non-ischemic mitral valve disease.

OBJECTIVES: Mitral valve combined with coronary artery surgery is associated with a higher hospital mortality than each operation in particular. Controversy exists regarding the predictive value of ischemic mitral valve disease (MVD) on outcome. METHODS: Between 1984 and 1997, 262 patients underwent mitral valve operations (replacement, n = 198; repair, n = 64) in combination with coronary revascularization. The etiology of MVD was secondary to ischemic heart disease (group I) in 82 (31%) patients, and non-ischemic (group II) in 180 (69%) patients (rheumatic, 139 patients (53%); degenerative, 41 patients (16%)). Both groups were similar in age, cardiac risk factors and pulmonary artery pressure. Patients of group I had significantly more severe coronary artery disease, more often an impaired left ventricle and myocardial infarction, and were in a worse functional condition. The mean number of bypass grafts was significantly higher in group I. The follow-up was 98% (230/234 patients). RESULTS: With 19.5%, the hospital mortality was significantly increased in group I compared with 6.7% in group II (P = 0.002; overall, 10.7%). Mitral valve repair or replacement had no influence on early outcome, although mitral valve repair was performed more often in group I (37 versus 19%). The survival (valve-related event-free survival) after discharge from hospital in the 1st, 5th and 10th year was 94 (94%), 70 (66%) and 53% (35%) in group I and 96 (95%), 79 (76%) and 54% (41%) in group II, respectively. The long-term functional capacity was equally good in both groups (New York Heart Association mean, 1.86 versus 1.72). CONCLUSIONS: Patients with ischemic MVD are in a worse cardiac condition with significantly higher hospital mortality than patients with non-ischemic MVD and coronary artery bypass grafting. Once discharged from hospital, both groups have comparable long-term outcomes, with the best results in patients with degenerative MVD.

Aged↗
PubMed1987

Replacement of the aortic valve with cryopreserved aortic valve allograft: considerations and techniques in children.

Normal structure and function of the aortic valve requires not only the basic three-cusp architecture but also the dynamic action and shape of the aortic sinuses and correct diameter relationships at the left ventricular outlet and at the aortic sinus rim. Congenital malformation of the aortic valve implies abnormality of the aortic cusps and, additionally, there may be deformity of the aortic sinuses or the subvalvular left ventricular outflow tract or the supravalvular aorta. Aortic valve replacement in children using an aortic valve allograft often requires enlargement of the left ventricular outflow tract or restoration of aortic sinus configuration. Careful consideration of the malformations of the aortic root and planning of reconstructive operation is required lest the malformation be recreated in the allograft valve replacement. Even the best execution of known aortic root reconstructive or left ventricular outflow tract enlarging operations has limitations in restoration of normal structure and compliance of the aortic root. Consequently, there remain many unknown factors that could affect late results of aortic valve allograft operations in children compared to those results observed in adult patients.

Aorta↗
PubMed1995

Detection of mechanical changes to prosthetic heart valves by spectral analysis of valve closing sounds.

This study investigates the possibility of using spectral analysis of the closing sounds of a prosthetic heart valve to indicate minor changes to its mechanical state. Sounds are recorded in vitro in a large effectively anechoic tank of water, and the elastically mounted valve is actuated pneumatically within the water. This provides a noise-free environment for recordings. Analysis of the valve sounds is by spectral averaging and digital filtering, with each individual valve used to create its own filter. Results show that it is possible using this technique to detect reliably changes in the mechanical state of a valve, such as the addition of a small mass to the structure of the valve.

Acoustics↗
PubMed1999

Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery.

BACKGROUND: The surgical approach to aortic root aneurysm and/or dissection remains controversial. The use of valve-sparing operations, which are thought to have many advantages, is increasing. We hypothesized that the particular technique and type of surgery could influence valve motion characteristics and function. Therefore, we studied the instantaneous opening and closing characteristics of the aortic valve after the main 2 types of valve-sparing surgery. METHODS AND RESULTS: In 20 patients (10 with tube replacement of the aortic root, group A; and 10 with separate replacement of the sinuses of Valsalva, group B) and 10 controls (group C), transthoracic and transesophageal studies on aortic valve dynamics were performed. Three distinct phases of aortic valve motion were identified. They were as follows: (1) a rapid opening, with a velocity of 20.9+/-4.2 cm/s in group C, 27.1+/-10.9 cm/s in group B (P=NS), and 58.3+/-18.4 cm/s in group A (group A versus group C, P<0. 001; group A versus group B, P=0.001); (2) a slow systolic closure, with 12.5+/-6.6% and 10.8+/-2.2% of maximal opening in groups C and B, respectively (P=NS), and 3.8+/-1.6% in group A (group A versus group C, P=0.001; group A versus group B, P<0.001); and (3) a rapid closing movement, with a velocity of 26.3+/-5.6 cm/s in group C, 32. 4+/-11.4 cm/s in group B (P=NS), and 21.8+/-3.5 cm/s in group A (group A versus group C, P=NS; group A versus group B, P=0.008). The pressure strain of the elastic modulus was different in groups C and B only at the commissures (682+/-145 g/cm(2) versus 1896+/-726 g/cm(2), respectively; P<0.001). At all root levels, the distensibility was reduced in group A (P<0.001). Systolic contact of aortic cusps and wall occurred only in group A. CONCLUSIONS: Near-normal opening and closing characteristics can be achieved by a technique that preserves the shape and independent mobility of the sinuses of Valsalva.

Adult↗
PubMed2004

The role of palmaris muscle tendon in mitral valve annulus reconstruction: a novel technique for mitral valve repair.

BACKGROUND: Autogenous tissue for heart valve repair is limited to pericardium and fascia lata. Prosthetic annuloplasty rings have limitations and are expensive. No previous cadaveric study has documented autotransplantation of forearm tendons for mitral valve repair. The purposes of this anatomical study were (1) to determine the feasibility of using tendons for annular reconstruction during mitral valve repair (band or ring shape) and (2) to compare the metric dimensions and gross morphology with those of prosthetic rings. METHODS: The palmaris tendon (PM) (n = 7) was harvested from forearms of human cadavers and prepared in the dissecting room. The tendon was incorporated along the valve annulus. Surgery consisted of mitral valve annuloplasty performed with an undersized and a complete tendon. RESULTS: On gross handling PM tissue was morphologically resilient. Preparation and use of PM for annuloplasty were feasible. Anatomical reconstruction of the annulus with autogenous tissue using this tendon also was feasible. The annulus behaved as a flexible ring that allowed for improved atrioventricular continuity. Complete (n = 7) and partial (n = 7) annuloplasty rings were constructed. Metric dimensions were similar to those of prosthetic rings. CONCLUSION: PM is a suitable novel autogenous tissue that can be harvested together with the radial artery and has direct relevance in ischemic mitral valve regurgitation. These tendons can be easily utilized to achieve results similar to those of pericardial reconstruction and prosthetic annuloplasty rings. The tissue is readily available from the patient, and no extra cost is incurred. Further chemical studies in the human subjects are warranted.

Cadaver↗
PubMed2000

[Necessity of permanent anticoagulant therapy for isolated mitral valve replacement with bioprosthetic heart valve to prevent the postoperative thromboembolic complications].

One hundred fifty four patients underwent isolated mitral valve replacement with bioprosthetic heart valve at Hyogo Medical College Hospital from November 1973 to December 1998. A porcine bioprosthetic valve was replaced in 82 patients (Hancock 43, Carpentier-Edwards 26, Hancock II 13) and pericardial bioprosthetic valve in 72 patients (Ionescue-Shiley 39, Carpentier-Edwards 33) with a mean follow-up of 1,410 patients-years. Their thromboembolism rates were also analyzed in linear and actuarial term over the 15-year period. The incidence of thromboembolism rate was 2.5%/pt.yr. Thromboembolic free rates for patients with anticoagulant therapy were significantly decreased for patients without therapy. Thromboembolic free rates for patients with atrial fibliration were also were significantly decreased for patients with sinus rhythm because the patients with sinus rhythm were not on anticoagulant therapy. In conclusion, it is necessary for the all patients to be on anticoagulant therapy after mitral valve replacement with bioprosthetic valves, even though patients with sinus rhythm.

Adult↗
PubMed2006

Management of commissural lesions in native mitral valve endocarditis: long-term results of valve repair and partial homograft replacement.

BACKGROUND AND AIM OF THE STUDY: Commissural lesions in the context of native mitral valve endocarditis are a technically challenging condition for conservative surgery. Herein are reported the authors' 10-year results for mitral valve repair (MVRep) or partial homograft replacement (PHR) performed in this setting. METHODS: Data were reviewed from 19 consecutive patients who underwent MVRep using either Carpentier's technique (n = 14) or PHR (n = 5) for endocarditis at the authors' institution between 1989 and 1994. RESULTS: There was one operative death (5%; 95% CI 0-15.5%). Two reoperations were performed in each subgroup for recurrence of endocarditis (n = 2) and mitral valve failure (n = 2). The 10-year survival rate and freedom from mitral valve reoperation were 95% (95% CI 84-100%) and 78% (95% CI 59-97%), respectively. At 10 years, 13 (93%) surviving and non-reoperated patients were in good functional status (NYHA class I-II), and 14 (100%) were in sinus rhythm. Although echocardiographic results were excellent in the MVRep group, all PHR patients had moderate or severe mitral valve dysfunction. CONCLUSION: Commissural reconstruction using Carpentier's techniques demonstrated excellent long-term results in patients with native mitral valve endocarditis. In contrast, the results for PHR were rather disappointing.

Adolescent↗
PubMed1986

Architecture of the ventricular mass and atrioventricular valves in complete transposition with intact septum compared with the normal: I. The left ventricle, mitral valve, and interventricular septum.

Venous correction for complete transposition with intact ventricular septum remains the preferred surgical option in most centers (Mustard or Senning procedures). The long-term function of the morphologically right ventricle and tricuspid valve, which continue to sustain the systemic circulation thereafter, remains a matter of concern. Some centers have been performing arterial redirection ("arterial switch") as the surgical treatment of transposition. Consequently, the status of the left ventricle and mitral valve is of equal interest. Yet, detailed morphological studies of the ventricles, atrioventricular valves, and their tension apparatus in "simple" complete transposition are lacking. We have examined the morphology of the left ventricle and the spatial relationships of the component parts of the interventricular septum (part I) as well as the morphology of the right ventricle and the tricuspid valve (part II). A total of 77 specimens with complete transposition and intact ventricular septum were examined and compared with 50 normal hearts. Consistent deformities were noted in relation to the orientation of the ventricular septum. The ratios of ventricular outlet to the inlet lengths were increased in both ventricles and the posterior arterial valve was abnormally related to the atrioventricular valves. These anomalies are similar in some respects to those found in atrioventricular septal defects. Their significance in relation to long-term function remains unclear.

Child, Preschool↗
PubMed1981

[Tricuspid valve motion and tricuspid valve ring size in normals and patients with atrial septal defect (author's transl)].

To investigate the normal configuration of the tricuspid valve and the normal size of the tricuspid valve ring, 17 normals, 20 patients with atrial septal defect, 4 patients with tricuspid valve prolapse, and 41 patients with various diseased conditions were studied by cross-sectional echocardiography. The tricuspid valve ring diameter in atrial septal defect was judged to be increased in comparison with that of normals. All the patients with tricuspid valve prolapse exhibited an excessive systolic ballooning of the leaflets toward the right atrium. However, a systolic ballooning of the leaflets alone was frequently observed in normals and many other conditions. Therefore, we conclude that cross-sectional echocardiography has some clinical limitations in the differential diagnosis between tricuspid valve prolapse and normals.

Adult↗
PubMed1995

Similar quality of life after heart valve replacement with mechanical or bioprosthetic valves.

The goal of this study was to determine if there was a difference in the quality of life (QoL) between patients receiving bioprosthetic (Biocor, BIO) or mechanical (St. Jude Medical, SJM) valve prosthesis. In January 1993 we assessed the psychological outcome of heart valve surgery among 183 (87 BIO, 96 SJM) of 220 survivors in a selected and matched cohort of 140 BIO and 140 SJM recipients who had their valve replacement between 1983 and 1989. The BIO and SJM groups were equal in terms of mean age, gender, valve position, educational level, marital status and follow up time. Questions concerning QoL, in terms of coping capacity, social support, and general emotional status as well as emotions concerning valve-related complications, were answered by the patients marking a non-graded visual analogous scale, ranging from total agreement to total disagreement. We found no significant difference between patients receiving BIO and those receiving SJM prostheses regarding coping capacity (62 +/- 2 vs. 65 +/- 2), social support (77 +/- 3 vs. 76 +/- 2), or emotional status (63 +/- 3 vs. 65 +/- 3). When subdividing patients by age below and above 60 years, gender, functional class, valve position and complication, we found several significant differences, but the two prosthetic groups were largely similar. Females had a significantly lower level of coping capacity and emotional status than males. Coping capacity and emotional status were significantly correlated with functional class, while social support was not. Coping capacity tended to be lower among patients who had experienced complications and this was more pronounced with BIO.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

Prediction of valve-related complications for artificial heart valves using adaptive neural networks: a preliminary study.

A novel approach to the prediction of valve-related complications in patients with implanted artificial heart valves is discussed. Adaptive artificial neural networks were used to identify patients at high risk of valve-related events based on preoperative data. Data from a clinical trial on 789 subjects with Carpentier-Edwards pericardial bioprostheses were used. Patients' records were divided into two groups, one of which was used for training the neural network and the other for testing the trained network and determining error rates. Patient information such as age, sex, NYHA class and anticoagulation therapy, as well as valve information such as size and the date of implant, were used as the network inputs. The neural net had a single output variable indicating the risk that an individual patient would develop a valve-related complication resulting in death. The results show that a trained neural network was able to predict valve-related deaths in the specified time interval of 1981-1991 with a high degree of accuracy. The neural network was also successful in classifying patients into high and low risk categories.

Animals↗
PubMed1997

Composite valve graft versus separate aortic valve and ascending aortic replacement: is there still a role for the separate procedure?

BACKGROUND: To ascertain if operative technique has any bearing on outcome, the surgical results after aortic root replacement using either a composite valve graft (CVG) or a separate graft and valve (GV) were analyzed. METHODS AND RESULTS: Three hundred and ninety consecutive, nonrandomized patients treated for aortic valve disease and ascending aortic aneurysm (n=278) or type A dissection (n=112 [45 acute]) between 1965 and 1995 were analyzed retrospectively. One hundred and thirty-five patients received a CVG, and 255 had separate GV replacement. Mean age was 52+/-16 years (+/-1 SD). Eighty-two patients (44% of the CVG group) had the Marfan syndrome (MFS). Follow-up (96% complete) totaled 2247 patient-years and extended to 27 years. The operative mortality rate was 10+/-3% (+/-70% confidence limits) for patients receiving a CVG and 15+/-2% for GV replacement (P=NS). The 15-year actuarial survival estimate was higher for the CVG group (53+/-14% [+/-SEM] versus 36+/-4%, P=.037). Seven patients in the CVG group required reoperation on the aortic valve or ascending aorta, as did 49 in the GV group. The probabilities of freedom from reoperation on the aortic rootwere 82+/-9% and 75+/-4% at 10 years for the CVG and GV group (P=NS). Thirty variables were analyzed in a multivariate model: pulmonary disease, higher New York Heart Association functional class, and longer cardiopulmonary bypass time were linked with higher operative mortality risk; older age, emergency operation, coronary artery disease, and liver dysfunction were independent determinants of late death. Younger age and use of a bioprosthesis were predictors of late reoperation. Type of procedure (GV versus CVG) was not a significant predictor of any outcome variable. CONCLUSIONS: The long-term results after CVG or GV were similar, which reflects proper patient selection. Use of a composite valve graft theoretically confers more protection against recurrent aortic root aneurysm, and, unless one opts for a valve-sparing aortic root replacement procedure, is most appropriate for younger patients, those with the MFS (including acute dissections), and others with marked pathological involvement of the sinuses. On the other hand, use of a separate GV should not be abandoned; in carefully selected patients (and if properly performed, eg, excision of the sinuses), GV also provides satisfactory results.

Adult↗
PubMed1979

Clinical and haemodynamic observations after combined aortic and mitral valve replacement with the Björk-Shiley tilting disc valve prosthesis. Early and late results in 25 patients.

Combined mitral and aortic valve replacement with the Björk-Shiley tilting disc valve (pyrolite) was performed in 25 unselected patients characterized by markedly impaired functional capacity, hypokinetic central circulation and cardiomegaly before operation. Surgery was performed during extracorporeal circulation with deep hypothermia. The mitral valve was replaced first in all cases. There were no intra-operative deaths, but 2 patients died while still in hospital (8.0%). One patient died 2 months postoperatively due to progressive heart failure. The remaining patients--with the exception of one who had died of cancer of the ovary--were re-examined in average 28.7 (18-40) months postoperatively. Most patients had improved symptomatically and were in functional classes I-II (N.Y.H.A.). The haemodynamic findings indicated restoration to normal resting values of cardiac output, pulmonary artery pressure and pulmonary vascular resistance, but with an increase in left ventricular end-diastolic pressure (LVEDP). The mean diastolic gradient across the mitral prosthesis varied from 0 to 11 mmHg, while simultaneous pressure recordings from the left ventricle and the aorta, with one exception, disclosed no systolic pressure gradients (peak) across the aortic valve. Postoperative arterial thrombo-embolic complications occurred in 2 patients, resulting in only minor neurological sequelae.

Adult↗
PubMedDate not supplied

Late systolic stress-diameter relation in patients with aortic valve disease before and after valve replacement.

The end-systolic pressure-diameter ratio (Ees) and the maximal pressure-diameter ratio (Emax) during systolic ejection were determined in 10 control patients and 25 patients with aortic valve disease before and 18 months after successful valve replacement. The pressure-diameter ratio was determined from simultaneous M-mode echocardiograms and high-fidelity pressure measurements. A new index of myocardial contractility, as proposed by Pouleur and co-workers, was assessed from the late systolic stress-diameter relationship during one single heart cycle. The slope of this stress-diameter relationship was used for determination of myocardial contractility. Meridional wall stress was calculated from echo-pressure measurements at time intervals of 5 to 10 msec. The aortic valve patients were divided into two groups according to the preoperative angiographic ejection fraction: group 1 (ejection fraction greater than or equal to 57%) consisted of 16 patients and group 2 (ejection fraction less than 57%) of 9 patients. Standard hemodynamics showed a significant decrease in left ventricular end-diastolic pressure from 18 to 11 mm Hg in group 1 (P less than 0.01) and from 16 to 12 mm Hg (NS) in group 2. Peak systolic pressure decreased from 186 to 135 mm Hg (P less than 0.01) in group 1 and from 155 to 140 mm Hg (NS) in group 2. Left ventricular end-diastolic volume decreased from 137 to 105 ml/m2 in group 1 and from 225 to 150 ml/m2 in group 2 (P less than 0.05) whereas left ventricular ejection fraction remained unchanged in group 1 (67 versus 65%) and increased slightly in group 2 (45 versus 51%) following surgery. Emax and Ees were preoperatively significantly decreased in group 2 when compared to group 1. Postoperatively, Emax and Ees were no longer significantly different between the two groups although left ventricular ejection fraction remained significantly depressed in group 2 after surgery when compared to group 1. The slope of the late systolic stress-diameter relationship (beta) and the diameter at zero stress (D0) did not show any difference between the two groups pre- as well as postoperatively. Thus it is concluded that Ees and Emax might help to identify myocardial dysfunction in preoperative patients with aortic valve disease. However, in the presence of persistent myocardial dysfunction, as evaluated from systolic ejection fraction, following successful valve replacement, both Ees and Emax do not allow to identify patients with postoperative depressed myocardial function.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2003

Implantation of collar-reinforced sumit valve for patient with large calcified mass obstructing the mitral valve orifice.

A 56-year-old female had a severely calcified mitral valve annulus and a huge subvalvular mass. To avoid critical damages of the coronary artery and left ventricle, the annular calcification and the part of the mass adherent to the left ventricle were not resected. Then we performed mitral valve replacement using SuMit valve and collared reinforcement technique with xenopericardium without any major complications. The SuMit valve is designed to be placed in a supraannular position, and is useful to prevent valves from getting stuck.

Calcinosis↗
PubMed1984

Frequency and significance of M-mode echocardiographic evidence of mitral valve prolapse in clinically isolated pure mitral regurgitation: analysis of 65 patients having mitral valve replacement.

To assess the reliability of M-mode echocardiographic patterns of mitral valve prolapse (MVP) (echo MVP) in detection of morphologic evidence of MVP (morphologic MVP), operatively excised mitral valves and corresponding M-mode echocardiograms from 65 patients with chronic, severe, isolated, pure mitral regurgitation (MR) were studied. Of the 65 patients, 45 (69%) had echo MVP (either holosystolic or mid-to-late systolic prolapse patterns on preoperative M-mode echograms) and 42 (93%) of them had morphologic MVP; of the 3 without morphologic MVP, 2 had ruptured chordae tendineae from infective endocarditis and 1 had papillary muscle dysfunction from atherosclerotic coronary heart disease. Of the 20 patients without echo MVP, 14 (70%) had no morphologic MVP (9 had papillary muscle dysfunction from coronary heart disease, 4 had infective endocarditis on previous normal valves and 1 had rheumatic heart disease). Of the 48 patients with morphologic MVP, 42 (88%) had echo MVP and most had considerably dilated mitral anulae; the other 6 had ruptured chordae tendineae with less degrees of anular dilatation. Of the 17 patients without morphologic MVP, 3 had echo MVP (coronary artery disease in 1 and infective endocarditis on a previous normal valve in 2); of the 14 with neither echo nor morphologic MVP, 9 had papillary muscle dysfunction from coronary artery disease, 4 had infective endocarditis on previously normal valves and 1 had rheumatic heart disease. The patients with very dilated mitral anuli and leaflet areas generally had holosystolic (hammocking) patterns on echo; the patients with small anuli and leaflet areas usually had mid-to-late systolic (buckling) prolapse patterns.

Adult↗
PubMed1990

Frequency of acute myocardial infarction in valve repairs versus valve replacement for pure mitral regurgitation.

Three hundred thirty-five consecutive isolated mitral valve operations for mitral regurgitation in patients with no significant coronary artery disease were reviewed over a 26-month period for the presence of a perioperative acute myocardial infarction (AMI). Of 224 patients undergoing mitral valve repair 12 (5.4%) had electrocardiographic and cardiac enzyme evidence of perioperative AMI develop. Of 111 patients undergoing mitral valve replacement none had perioperative AMI develop as determined by electrocardiographic and enzyme criteria (p = 0.01). All 12 infarctions after valve repair involved the inferior wall by electrocardiographic or echocardiographic criteria. Although no patient had significant clinical difficulty in recovery, 7 of the 12 patients (58%) were left with Q waves upon hospital discharge. The etiology of the AMI is believed to be air emboli introduced at the time of testing valve competence during left ventricular insufflation under pressure. Changes in surgical technique may reduce or eliminate this complication.

Aspartate Aminotransferases↗
PubMed2004

Midterm results of aortic valve repair with the pericardial cusp extension technique in rheumatic valve disease.

BACKGROUND: The encouraging results of valve repair in the atrioventricular valves have influenced a decision about aortic valve (AV) reconstruction. We report our experience with pericardial cusp extension to repair rheumatic AV disease. METHODS: From 1993 to 1998, 46 patients (25 women, 21 men) with a mean age of 31.5 +/- 12.2 years (range, 15 to 58 years) underwent AV repair. Twenty-two (47.8%) patients had moderate and 24 (52.2%) had severe aortic insufficiency (AI). Severe cusp retraction was repaired with glutaraldehyde-treated autologous pericardium. Twenty-one patients had more than one maneuver (mean, 1.8) to attain competence besides augmentation, which consisted of the release of stenotic commissures (in 11 cases), thinning of the AV cusps (in 10 cases), and resuspension of the cusps (in 17 cases). Simultaneous mitral valve repair was performed on 17 patients. Eight patients received triple valve reconstruction. RESULTS: There was no early mortality. Thirty patients no longer had AI with any significant transvalvular gradients. Five patients were followed with mild residual AI, and 2 patients with moderate AI not requiring reoperation. Nine patients developing severe AI required AV replacement with a reoperation rate 19.6% (4.26%/patient-year). The mean interval between repair and reoperation was 28.2 +/- 18.3 months (range, 3 to 58 months). The mean observation time was 4.6 +/- 3 years (211.6 patient-years). Late mortality rate was 2.2% with 1 patient. The significant negative predictors of aortic reoperation determined by univariate analysis were preoperative New York Heart Association class (p = 0.002) and postoperative severe AI (p < 0.001). Cox hazard studies identified that all risk factors were insignificant for aortic reoperation. The actuarial rate of freedom from aortic reoperation was 76.1% +/- 7% at 7.5 years. CONCLUSIONS: Although AV repair by extension with pericardium is worth considering with an acceptable solution to achieve a good geometry from unequal cusps, especially in young rheumatic patients for preservation of the native AV, the patients should be followed periodically for reoperation risk.

Adolescent↗