Reparación de prolapso de velo por rotura en válvula aórtica

Abstract

IntroductionLeaflets prolapse causes a lack of central coaptation and increases tension excessively on them. This fact predisposes to their rupture. This video is presented in which an aortic valve sparing surgery is performed by rebuilding a broken and prolapsing leaflet as an alternative to prosthetic implant. Materials and methodsA 61 year-old patient with tricuspid aortic valve and aortic regurgitation grade iv due to a prolapse and rupture of right-coronary leaflet and dilated ascending aorta. A retrospective analysis was performed on 19 patients with aortic valve sparing surgery and an untreated aortic root (2011-2015). ResultsThe video shows an annuloplasty, broken leaflet reconstruction, prolapse elimination with central plications, supracoronary conduit implantation, and sinotubular junction annuloplasty. Aortic regurgitation was grade i after surgery.The retrospective analysis of the group showed a mean age of 64.3±16.9 years, of which 5 (26.3%) were women. The Logistic EuroSCORE was 9.4±7.6, and the EuroSCORE II was 3.9±3.1. The procedures performed included, supracoronary conduit+aortic plasty in 11 (58%) and an isolated aortic plasty in 8 (42%). Pre-operative aortic regurgitation grade was iii (36.8%) and iv (63.2%). There were 3 (15.8%) conversions to prosthesis. Mean follow-up was 25.4±11.4 months (median 27), with 81% free not requiring re-intervention, and 69% free from aortic regurgitation>ii. ConclusionsAortic valve repair without addressing the root is more complex, due to its dynamic changes, and it is less stable over time.