FROM AORTIC CUSP EXTENSION TO VALVE-REPLACEMENT WITH STENTLESS PERICARDIUM

Between 1988 and 1994, 82 consecutive patients (median age 24 years) u nderwent reconstruction of the aortic valve with glutaraldehyde-treate d pericardium. Simultaneously, 29 of 30 mitral valves were repaired. T he first 27 patients underwent resection of the free edges and suture of a single strip of bovine pericardium. Transient ischemic changes su ggested the need for a change in technique. The subsequent 55 patients underwent total valve reconstruction with an autologous pericardium f ixed with glutaraldehyde in the appropriate shape and size according t o the patient's aortic annulus. There were one in-hospital and three l ate deaths. No patient received anticoagulation, and no embolic events were detected. Nine patients required reoperation as a result of fail ure of mitral valve repair in 4 and severe aortic regurgitation in 5 ( endocarditis [n = 2], commissural tear [n = 1], root dilation [n = 1], calcification of one bovine cusp [n = 1] at 58 months). There were no reoperative deaths. Complete linear echocardiographic follow-up of th ese patients showed low gradients, valve competence, and no progressiv e deterioration. No difference between techniques was detected.