Prolapse repair for aortic regurgitation in tricuspid aortic valves

Christian Giebels; Julia Schulze-Berge; Gudrun Wagenpfeil; Raphael Groß; Tristan Ehrlich; Hans-Joachim Schäfers

doi:10.1016/j.jtcvs.2023.06.002

Prolapse repair for aortic regurgitation in tricuspid aortic valves

J Thorac Cardiovasc Surg. 2023 Jun 10:S0022-5223(23)00463-4. doi: 10.1016/j.jtcvs.2023.06.002. Online ahead of print.

Authors

Christian Giebels¹, Julia Schulze-Berge¹, Gudrun Wagenpfeil², Raphael Groß¹, Tristan Ehrlich¹, Hans-Joachim Schäfers³

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany.
² Institute for Medical Biometrics, Epidemiology and Medical Computer Science, Saarland University Medical School, Homburg, Saar, Germany.
³ Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany. Electronic address: h-j.schaefers@uks.eu.

PMID: 37302467
DOI: 10.1016/j.jtcvs.2023.06.002

Abstract

Objective: Cusp prolapse is an important cause of aortic regurgitation (AR) in tricuspid aortic valves (TAVs) and can be caused by myxomatous degeneration or cusp fenestration. Long-term data for prolapse repair in TAVs are scarce. We analyzed the results of aortic valve repair in patients with TAV morphology and AR caused by prolapse and compared the results for cusp fenestration and myxomatous degeneration.

Methods: Between October 2000 and December 2020, 237 patients (221 male; 15-83 years) underwent TAV repair for cusp prolapse. Prolapse was associated with fenestrations in 94 (group I) and myxomatous degeneration in 143 patients (group II). Fenestrations were closed using a pericardial patch (n = 75) or suture (n = 19). In myxomatous degeneration, prolapse was corrected by free margin plication (n = 132) or triangular resection (n = 11). Follow-up was 97% complete (cumulatively 1531, mean 6.5, median 5.8 years). Cardiac comorbidities were present in 111 patients (46.8%), and more frequent in group II (P = .003).

Results: Ten-year survival was better in group I (I: 84.5%; II: 72.4%; P = .037), and patients without cardiac comorbidities (89.2% vs 67.0%; P = .002). Ten-year freedom from reoperation (P = .778), moderate or greater AR (P = .070), and valve-related complications (P = .977) were similar in both groups. AR at discharge was the only significant predictor for reoperation (P = .042). The type of annuloplasty did not affect repair durability.

Conclusions: Repair of cusp prolapse in TAVs with preserved root dimensions can be performed with acceptable durability, even in the presence of fenestrations.

Keywords: aortic valve repair; fenestration; prolapse; tricuspid aortic valve.