VALVE-SPARING CORRECTION OF AORTIC INCOMP ETENCE

The risk of valve-related complications and the necessity of anticoagu lation in patients with prosthetic valves, has led to new operative te chniques in the correction of severe aortic insufficiency. In the last 2 years, 35 patients (meanage 41.3 years, range 10-80 years) with aor tic insufficiency underwent reconstructive valve surgery. Eighteen pat ients had a commissuroplasty with or without triangular resection. In 5 patients with perforation, the valves could be reconstructed with a pericardial patch. In 12 patients with insufficiency due to aortic ane urysm, the valves were resuspended within the aortic prosthesis. In 2 patients the aortic valves were replaced intraoperatively because of u nsatisfactory results. The perioperative mortality was 5.7%. The echoc ardiographic degree of aortic insufficiency decreased from 3.3 +/- 0.5 preoperatively to 0.45 +/- 0.53 postoperatively. Two patients were re operated within the first week. Five of 23 patients at 1-year follow-u p have mild to moderate aortic insufficiency. Mean ventricular dimensi ons and function at discharge and after 1-year follow-up are normal. W ith the new operative techniques described recently, valve-sparing cor rections of aortic insufficiency are possible in an increasing number of patients, and autologous valve tissue can be saved. With more refin ement of surgical technique, early postoperative results will further improve.