Long-term results of conservative repair of rheumatic aortic valve insufficiency

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Abstract
From July 1974 to January 1986, 50 patients underwent conservativerepair for rheumatic aortic valvular disease at our institution. Elevenwere male and 39 female, with an average age of 39.5 years (range 17- 57).The aortic lesion was associated in all cases with a predominant mitrallesion. Twenty-five also had tricuspid disease which was surgically treatedin 17. Twenty-six had aortic regurgitation and 24, a mixed lesion. Thesurgical techniques used were: (1) commissurotomy, (2) annuloplasty, (3)cusp free edge unfolding and (4) supra-aortic crest enhancement. Twopatients had one cusp extended with pericardium. There were 3 hospitaldeaths (6%). Six patients were lost to follow-up at different periods.Maximum follow-up was 12.58 years with a mean of 7.78 years per patient.Twelve required reoperation with 3 deaths. Three reoperations were due tofailure of the mitral bioprosthesis without reoperation on the aorticvalve. Of the remaining 9 patients who had aortic and mitral dysfunction, 4had severe aortic insufficiency. The actuarial freedom from reoperation at13 years was 75% and the overall actuarial survival was 86%. It isconcluded that these surgical techniques can be applied successfully inmoderate rheumatic aortic valve disease accompanying a predominant mitrallesion. This is particularly relevant when a mitral reconstruction has beenperformed.

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