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Long Term Results for a Single Centre Aortic Valve Repair Program
Andrea Mangini1, Monica Contino1, Claudia Romagnoni1, Massimo Lemma1, Guido Gelpi1, Paolo Vanelli1, Simone Colombo1,
Carlo Antona2.
1L sacco University Hospital, Milano, Italy, 2Università degli Studi di Milano, Milano, Italy.

ABSTRACT: Long Term Results for a Single Centre Aortic Valve Repair Program OBJECTIVE: Aortic valvuloplasty seems to be a good alternative to valve replacement for lots of reasons: optimal hemodynamic conditions, absence of prosthetic material , no need of anticoagulation; moreover this kind of surgery allows, in young people, normal aortic annulus growth. Now that aortic valve repair techniques have reached a good standardization level, we want to analyze our medium and long term results in terms of freedom from reoperation and freedom from significant aortic regurgitation, in cases of incompetence due to leaflets and root pathology. METHODS: From January 2003 to January 2013 we prospectively identified 235 patients affected by aortic valve regurgitation caused by leaflets pathology (prolapse, fibrosis or retraction) or root dilatation to be treated with a combination of the principal leaflet repair techniques and, when necessary, sparing procedures. Of these, 218 patients were considered eligible in this study. All of them were submitted to: pre and post-operative trans-thoracic echocardiography, pre and post-repair trans-esophageal echocardiography. We standardized our technique dividing the procedure in 4 different moments: valve analysis, leaflets repair, aortic functional unit repair, aortic functional unit stabilization. Follow-up was achieved with periodic echocardiograms and clinical evaluations. RESULTS: 8 patients (3.40%) died before discharge. Median clinical and echocardiographic follow-up for all patients was 1075,00 [515,25-1975,25] days. Mean cross clamping time was 101.94±40.22 minutes and mean hospital stay was 10±6.69 days. Kaplan-Meier freedom from aortic regurgitation >2 and freedom from aortic valve replacement were respectively 92.9±2.8% and 94.5±2.5% at 9,24 years: 6 patients (2.75%) were re-operated with aortic valve replacement for severe aortic regurgitation. We also observed a good effect of aortic surgery on left ventricle: the end-diastolic volume decreased from 137.89±50.23ml in the pre-op to 105.17±31.19ml at follow-up. CONCLUSIONS: Aortic valve leaflet repair seems to be a good and feasible option for selected patients both alone or associated with an aortic sparing technique concerning long-term results. The development of this process was possible thanks to a better comprehension of aortic anatomy and of the pathogenetic mechanisms at the base of the aortic regurgitation.

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