Reconstructive surgery of the aortic valve

OBJECTIVE: Lacking an ideal valve substitute and motivated by the good results of mitral valve repair since 1990, we faced with determination aortic valve reconstruction surgery. The objective of this paper is to show our experience with this procedure. METHOD: Between January of 1990 and December of 2001; 136 aortic valve repair surgeries were performed. Seventy-five (55.1%) of the patients were female and the ages ranged from 4 to 70 years (mean 23.3 ± 1.2 years). Every patient had rheumatic valve disease and insufficiency was the most prevalent type (108 patients - 79.4%), followed by double aortic lesion in 16 (11.7%) patients and stenosis in 12 (8.8%). The surgical techniques used were: subcommissural annuloplasty in 74 (54.4%) patients, commissurotomy in 38 (27.9%), cusp extension with pericardium in 17 (12.5%), substitution of one cusp in 2 (1.4%), cusp suspension by annuloplasty in 37 (27.2%) and Valsalva sinus remodeling in 27 (19.8%). The surgery exclusively involved the aortic valve in 57 (41.9%) patients and was associated in 79 (mitral valve replacement in 12, mitral repair in 65, coronary artery bypass grafting in 1 and pulmonary commissurotomy in 1). RESULTS: Hospital mortality was 2.2% and 22 (16.2%) patients underwent a new surgery during the follow-up period (57.7 ± 3.5 months). CONCLUSIONS: Aortic valve repair is a safe surgical procedure that can be used in an increasing number of patients with promising results.