Aortic Valve Reconstruction

From September 1994 to September 1999, 50 patients underwent successful aortic valve reconstruction. Four were lost to follow-up, there were 2 early and 2 late deaths. The remaining 35 males and 11 females (mean age, 39.1 years) were followed up for 1 to 61 months (mean, 30.75 months). Most had rheumatic disease (27), the others had infective endocarditis (16) or degenerative disease (3). There was isolated aortic valve disease in 22 cases, double-valve disease in 16, triple-valve disease in 7, and 1 other. Preoperative aortic regurgitation was severe in most cases and the mean ejection fraction was 55.3%. Surgical procedures included subcommissural annuloplasty (14), cusp thinning (13), commissurotomy (10), and free-edge unrolling (10). Cusp extension with autologous pericardium was performed in 9 patients and aortic valve replacement with autologous pericardium in 22. Nine patients needed aortic valve replacement at a mean of 15.8 months postoperatively. The other 33 patients experienced marked improvements in aortic valve function. Aortic valve reconstruction is recommended in selected patients but reoperation remains an important problem. Long-term follow-up is needed to assess the role of this operation.