Abstract 1804: Aortic Valve Repair for Pure Regurgitation: a Tailored Surgical Approach to the Individual Pathology

Background : Pure aortic valve regurgitation has a variety of mechanisms related to the leaflets, root pathology or a combination thereof. Accurate recognition of the underlying mecanism(s) has allowed us to systematically use a tailored patient-to-patient surgical approach for valve reconstruction. Methods : Between January 1996 and February 2006, 292 patients underwent elective aortic valve repair and preservation at our Institution. Root and ascending aorta dilatation was corrected by subcommissural annuloplasty (n=157 pts), supracommissural aortic plication (n=50 pts) or replacement, root remodelling (n= 52 pts) or valve reimplantation into a graft (n= 119 pts). Cusp prolaps was corrected by plication (n= 57 pts), triangular resection (n = 24 pts) or free margin shortening with PTFE (n= 137 pts). Finally, pericardial patchs were used to close for cusps defects in 26 pts. Cumulative and mean follow-ups were respectively 9475 and 32 months. They were 99% complete;. Results : Hospital mortality was 0.7 % (2 pts). Four pts underwent reoperation for early recurrence of AR. During follow-up, 3 pts had a late reoperation for recurrent AR. Actuarial freedom from recurent AR at 5 years was 95 ± 4% for isolated valve repair, 97 ± 3% for isolated root replacement and 96 ± 3% for combined valve repair and root replacement. Actuarial freedom from reoperation at 5 years was 99 ± 1% and no patient presented with endocarditis. Conclusion : A systematic and individually tailored approach may allow cardiac surgeon to achieve a safe and durable aortic valve repair with low valve related morbidity and mortality.