Basal cusp enlargement for repair of aortic valve insufficiency

Objective: The aim of this study was to evaluate the clinical and echocardiographic results after aortic valve reconstruction with a novel surgical technique consisting of basal cusp enlargement with an autologous pericardial patch.

Methods: Between December 2005 and June 2008, a total of 106 consecutive patients underwent elective valve-sparing aortic root repair at Cardiovascular Clinic, Bad Neustadt, Germany. Fifty-nine patients required additional procedures on the aortic cusps; among them, in 10 cases basal cusp enlargement was used for restoration of coaptation area. All these patients had an ascending aortic aneurysm combined with aortic insufficiency, which was severe (4+) in 2 cases and moderate to severe (3+) in 4. The root repair was performed with valve reimplantation (David technique) in 1 case and the author's own single-patch technique in the other 9. Partial and total arch replacements were performed in 3 and 1 cases, respectively.

Results: The postoperative echocardiography at discharge showed no aortic regurgitation in 7 cases and trivial regurgitation in 3. The average coaptation height of the leaflets was 9.9 + or - 0.6 mm, and the mean gradient across the valve was 5.4 + or - 1.9 mm Hg. At follow-up as late as 31 months, all patients were alive with echocardiographic findings unchanged from the early postoperative examinations.

Conclusions: The technique presented here allows an individualized reconstruction of the aortic cusps, leading to considerable improvement in coaptation area, in patients who have aortic leaflet prolapse or restriction caused by complex aortic root and valve disease.