Korean J Thorac Cardiovasc Surg 2019; 52(1): 9-15  https://doi.org/10.5090/kjtcs.2019.52.1.9
Long-Term Results of the Leaflet Extension Technique for Rheumatic Aortic Regurgitation: A 20-Year Follow-up
Yu-jin Kwak, M.D.1, Hyuk Ahn, M.D., Ph.D.2, Jae Woong Choi, M.D.1, Kyung-Hwan Kim, M.D., Ph.D.1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University, College of Medicine, 2Department of Thoracic and Cardiovascular Surgery, Bundang Jesaeng Hospital
Corresponding author: Hyuk Ahn, Department of Thoracic and Cardiovascular Surgery, Bundang Jesaeng Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea
(Tel) 82-31-779-0160 (Fax) 82-31-779-0929 (E-mail) ahnhyuk@snu.ac.kr
Received: August 17, 2018; Revised: November 7, 2018; Accepted: November 7, 2018.; Published online: February 5, 2019.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

cc This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Although aortic valve repair can reduce prosthesis-related complications, rheumatic aortic regurgitation (AR) caused by leaflet restriction is a significant risk factor for recurrent AR. In this study, we evaluated the long-term results of the leaflet extension technique for rheumatic AR. Methods: Between 1995 and 2016, 33 patients underwent aortic valve repair using the leaflet extension technique with autologous pericardium for rheumatic pure AR. Twenty patients had severe AR and 9 had combined moderate or greater mitral regurgitation. Their mean age was 32.2±13.9 years. The mean follow-up duration was 18.3±5.8 years. Results: There were no cases of operative mortality, but postoperative complications occurred in 5 patients. Overall survival at 10 and 20 years was 93.5% and 87.1%, respectively. There were no thromboembolic cerebrovascular events, but 4 late deaths occurred, as well as a bleeding event in 1 patient who was taking warfarin. Twelve patients underwent aortic valve reoperation. The mean interval to reoperation was 13.1±6.1 years. Freedom from reoperation at 10 and 20 years was 96.7% and 66.6%, respectively. Conclusion: The long-term results of the leaflet extension technique showed acceptable durability and a low incidence of thromboembolic events and bleeding. The leaflet extension technique may be a good option for young patients with rheumatic AR.
Keywords: Leaflet extension, Aortic valve, regurgitation, Rheumatic diseases


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