CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 142 AFRICA In TEE after CPB, a prerequisite for a successful repair is a coaptation length of at least 5 mm in the middle of the free border and an effective height of 8–10 mm. The presence of residual moderate AR or mild eccentric AR was an indication for re-exploration of the aortic valve.14,15 Transthoracic echocardiography (TTE) was performed on all patients in the early postoperative stage and after discharge, during follow up. Aortic valve insufficiency was evaluated using recent literature and international guidelines. Aortic valve insufficiency was categorised as: trace or trivial (0); mild (1); moderate (2); moderate–severe (3); or severe (4+). When the regurgitant volume was used to grade AI, 0 indicated no regurgitation; 1+ was a regurgitant volume < 30 ml; 2+ was a regurgitant volume of 30–44 ml; 3+ was a regurgitant volume of 45–60 ml; and 4+ was a regurgitant volume > 60 ml. Postoperative length-of-stay calculations excluded patients who had died in hospital. Two (4.2%) of the patients died within the first 30 days postoperatively and were included as early mortalities. Therefore, data from these two patients were excluded when calculating the median postoperative length of stay. Intra-operative conversion to a valve-replacing procedure because of severe valve dysfunction was considered repair failure.16 One patient had severe AI at postoperative day one and we had to perform an aortic valve replacement (AVR). The clinical follow up extended from 2.5 months to 9.8 years with a mean of 5.7 ± 3.1 years. The follow up was ended on 31 April 2022. The contact information of 45 live patients was obtained. These patients were contacted at six-month intervals and the data obtained were recorded. All of the patients were followed up every year as out-patients. Results were evaluated in terms of overall survival, incidence of re-operation, degree of residual aortic valve insufficiency and incidence of postoperative complications. Statistical analyses Statistical analyses were performed utilising SPSS version 23 software (SPSS, Inc, Chicago, IL, USA). The conformity of variables to a normal distribution was examined via visual (histogram and probability graphics) and analytical methods (Kolmogorov–Smirnov or Shapiro–Wilk tests). The definitive analysis was obtained using frequency tables for categorical variables and mean and standard deviation for normally distributed variables. Intensive care unit stay and discharge time were not normally distributed. They are given as median and interquartile range. Survival and freedom from re-intervention on aortic valve data were obtained from life table analyses and are presented with standard error. Fig. 3. The completed modified David V procedure is shown. Two different-sized grafts are used in this technique. The graft used in proximal position is always larger than the distal graft. Fig. 2. A. Measuring position of the diameter of the STJ for optimum valve coaptation. B. The modified David V intra-operative proximal graft sizing; in this case, the imaginary STJ is approximately 25 mm. Adding 5 mm to this value, the total value is the proximal graft size. A B
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