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Early results of aortic valve reconstruction with stentless glutaraldehyde treated autologous pericardial valve

  • Chander Mohan Mittal
  • Sachin Talwar
  • Velayoudham Devagourou
  • S. S. Kothari
  • A. Sampath Kumar
Original Article

Abstract

Introduction

Aortic valve reconstruction (AoR) using single strip of autologous glutaraldehyde treated pericardium is a substitute for aortic valve replacement. We present our early results with the use of this technique.

Methods

Between November 2006 and December 2008, we successfully performed AoR with stentless glutaraldehyde treated autologous pericardial valve in 34 patients. The mitral valve was repaired in 26 of these patients. Trans-thoracic echocardiography (TTE) was performed in all patients prior to discharge and thereafter at 3 monthly intervals. Valve deterioration, thrombo-embolic complications, hemorrhage or infective complications were noted during follow-up.

Results

There was one operative death. After mean follow-up of 16.3±8.6 months (range 4 to 29 months) low moderate to moderate AR was reported in 9 patients on TTE. AR free survival was 72.2±7.9% at a median follow-up of 14.2 months. None of the patient had any thrombo-embolic complications. None of the patients had any significant AS.

Conclusion

Aortic Valve reconstruction using glutaraldehyde treated autologous pericardium is feasible in young patients with acceptable results.

Key words

Mitral valve Aortic valve Echocardiography 

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References

  1. 1.
    Edmunds LH Jr. Thromboembolic complications of current cardiac valvular prostheses. Ann Thorac Surg 1982; 34: 96–106.PubMedGoogle Scholar
  2. 2.
    Al-Fagih MR, al Kasab SM, Ashmeg A. Aortic valve repair using bovine pericardium for cusp extension. J Thorac Cardiovasc Surg 1988; 96: 760–766.PubMedGoogle Scholar
  3. 3.
    Goetz WA, Lim HS, Lansac E, Weber PA, Duran CM. A temporarily stented, autologous pericardial aortic valve prosthesis. J Heart Valve Dis 2002; 11: 696–702.PubMedGoogle Scholar
  4. 4.
    Duran CM, Gometza B, Kumar N, Gallo R, Martin-Duran R. Aortic valve replacement with freehand autologous pericardium. J Thorac Cardiovasc Surg 1995; 110: 511–516.CrossRefPubMedGoogle Scholar
  5. 5.
    Al Halees Z, Al Shahid M, Al Sanei A, Sallehuddin A, Duran C. Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothorac Surg 2005; 28: 200–205.CrossRefPubMedGoogle Scholar
  6. 6.
    Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 2006; 114: e84–231.CrossRefPubMedGoogle Scholar
  7. 7.
    Duran CM, Gometza B. Aortic valve reconstruction in the young. J Card Surg 1994; 9: 204–208.CrossRefPubMedGoogle Scholar
  8. 8.
    Kumar AS, Kumar RV, Shrivastava S, Venugopal P, Sood AK, Gopinath N. Mitral Valve Reconstruction-early results of a modified Cooley technique. Tex Heart Inst J 1992; 19: 107–111.PubMedGoogle Scholar
  9. 9.
    Choudhary SK, Talwar S, Dubey B, Chopra A, Saxena A, Kumar AS. Mitral valve repair in a predominantly rheumatic population: long-term results. Tex Heart Inst J 2001; 28: 8–15.PubMedGoogle Scholar
  10. 10.
    Akins CW, Miller DC, Turina MI, et al. Councils of the American Association for Thoracic Surgery; Society of Thoracic Surgeons; European Assoication for Cardio-Thoracic Surgery; Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg 2008; 135: 732–738.CrossRefPubMedGoogle Scholar
  11. 11.
    Zoghbi WA, Enriquez-sorano M, Foster E et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiography 2003; 16: 777–802.CrossRefGoogle Scholar
  12. 12.
    Talwar S, Saikrishna C, Saxena A, Kumar AS. Aortic valve repair for rheumatic aortic valve disease. Ann Thorac Surg 2005; 79: 1921–25.CrossRefPubMedGoogle Scholar
  13. 13.
    Ross DN. Surgical reconstruction of the aortic valve. Lancet 1963; 1: 571–574.CrossRefPubMedGoogle Scholar
  14. 14.
    Bjoerk VO, Hultquist G. Teflon and pericardial aortic valve prosthesis. J Thorac Cardiovasc Surg 1964; 47: 693–701.PubMedGoogle Scholar
  15. 15.
    Bahnson HT, Hardesty RL, Baker LD Jr, Brooks DH, Gall DA. Fabrication and evaluation of tissue leaflets for aortic and mitral valve replacement. Ann Surg 1970; 171: 939–947.CrossRefPubMedGoogle Scholar
  16. 16.
    Edwards WS. Aortic valve replacement with autogenous tissue. Ann Thorac Surg 1969; 8: 126–132.PubMedCrossRefGoogle Scholar
  17. 17.
    Senning A. Fascia lata replacement of aortic valves. J Thorac Cardiovasc Surg 1967; 54: 465–470.PubMedGoogle Scholar
  18. 18.
    David TE, Pollick C, Bos J. Aortic valve replacement with stentless porcine aortic bioprosthesis. J Thorac Cardiovasc Surg 1990; 99: 113–118.PubMedGoogle Scholar
  19. 19.
    Talwar S, Mohapatra R, Saxena A, Singh R, Kumar AS. Aortic homograft: a suitable substitute for aortic valve replacement. Ann Thorac Surg 2005; 80: 832–838.CrossRefPubMedGoogle Scholar
  20. 20.
    Sampath Kumar A, Talwar S, Saxena A, Singh R. Ross procedure in rheumatic aortic valve disease. Eur J Cardiothorac Surg 2006; 29: 156–161.CrossRefPubMedGoogle Scholar
  21. 21.
    Elkins RC, Thompson DM, Lane MM, Elkins CC, Peyton MD. Ross operation: 16-year experience. J Thorac Cardiovasc Surg 2008; 136: 623–630.CrossRefPubMedGoogle Scholar
  22. 22.
    Ruel M, Kulik A, Lam BK, et al. Long-term outcomes of valve replacement with modern prostheses in young adults. Eur J Cardiothorac Surg 2005; 27: 425–433.CrossRefPubMedGoogle Scholar
  23. 23.
    Emery RW, Emery AM, Krogh C, et al. The St. Jude Medical cardiac valve prosthesis: long term follow-up of patients having double valve replacement. J Heart Valve Dis 2007; 16: 634–640.PubMedGoogle Scholar
  24. 24.
    Filsoufi F, Rahmanian PB, Castillo JG, Bronster D, Adams DH. Incidence, imaging analysis, and early and late outcomes of stroke after cardiac valve operation. Am J Cardiol 2008; 101: 1472–1478.CrossRefPubMedGoogle Scholar
  25. 25.
    Panda BR, Shankar R, Kuruvilla KT, et al. Combined mitral and aortic valve replacement for rheumatic heart disease: fifteen-year follow-up and long-term results. J Heart Valve Dis 2009; 18: 170–179.PubMedGoogle Scholar
  26. 26.
    Talwar S, Mathur A, Choudhary SK, Singh R, Kumar AS. Aortic valve replacement with mitral valve repair compared with combined aortic and mitral valve replacement. Ann Thorac Surg 2007; 84: 1219–1225.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2009

Authors and Affiliations

  • Chander Mohan Mittal
    • 1
  • Sachin Talwar
    • 1
  • Velayoudham Devagourou
    • 1
  • S. S. Kothari
    • 2
  • A. Sampath Kumar
    • 1
    • 3
  1. 1.Cardiothoracic CentreAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Cardiology CentreAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Vihar DelhiIndia

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