Aortic valve repair by cusp extension with the use of fresh autologous pericardium in children with rheumatic aortic insufficiency

Objectives: Our goal was to evaluate the midterm results of aortic valve re pair by a more sophisticated tailoring of cusp extension-taking into accoun t the dimensions of the native aortic cusps-with the use of fresh autologou s pericardium. Patients and methods: Forty-one children who had severe rheu matic aortic insufficiency (mean age 11.5 +/- 2.7 years) underwent aortic v alve repair by means of this cusp extension technique over a 5-year period. Twenty-four of them underwent concomitant mitral valve repair for associat ed rheumatic mitral valve disease. All children were then followed up by tr ansthoracic echocardiography before discharge, at 3 and 6 months after the operation, and at yearly intervals thereafter. Results: Follow-up was compl ete in all patients and ranged from 3 months to 5 years (median 3 years). N o operative and no early postoperative deaths occurred. Only 1 patient died , 9 months after the operation, of septicemia and multiple organ failure. A ctuarial survival was 97% at 1 year and has remained unchanged at 3 years. On discharge, the degree of aortic insufficiency was grade for 27 children and grade I for 14. Exacerbation of aortic insufficiency from grade I to gr ade II was observed in only 1 patient, and none of the children required re operation for aortic insufficiency during the follow-up period. Mean peak s ystolic aortic valve gradients at discharge were lower than preoperative va lues (P = .04), and no significant increase in the peak systolic transvalvu lar gradient was detected thereafter during the follow-up period. Mean left ventricular dimensions were significantly reduced at discharge when compar ed with preoperative values (P < .0001). Conclusions: Functional results of aortic valve repair with cusp extension using fresh pericardium have been satisfactory at medium term, particularly in children with a small aortic a nulus at the time of initial repair, because the expansion potential of fre sh autologous pericardium is equivalent to that of the growing sinotubular junction and aortic anulus diameters.