Thorac Cardiovasc Surg 2020; 68(S 01): S1-S72
DOI: 10.1055/s-0040-1705370
Oral Presentations
Monday, March 2nd, 2020
Heart Valve Disease
Georg Thieme Verlag KG Stuttgart · New York

Midterm Outcome of Aortic Valve Reconstruction with Glutaraldehyde-Treated Autologous Pericardium

T. Suzuki
1   Sendai, Japan
,
K. Abe
1   Sendai, Japan
,
K. Yamaya
1   Sendai, Japan
,
M. Hata
1   Sendai, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2020 (online)

Objectives: Ozaki et al developed an original procedure to reconstruct aortic valve by suturing separate autologous pericardial leaflets. This technique was introduced to our institute, and applied to significant number of patients. The midterm outcomes of this series were retrospectively evaluated.

Methods: We evaluated 168 consecutive patients who underwent aortic valve reconstruction for various pathologies using separate autologous pericardium between March 2010 and March 2013. This patient cohort with aortic valve diseases was comprised of 107 (63.7%) aortic stenosis (AS), 39 (23.2%) aortic regurgitation (AR), and 22 (13.1%) AS associated with AR. Excised pericardium was treated with 0.6% glutaraldehyde solution. The distances between each commissure were measured, and the pericardial neo cusps were cut along with selected corresponding templates and sutured to each annulus. Early mortality, overall mortality, cardiac death, and freedom from reoperation are the major endpoints.

Results: Mean age was 73.0 ± 8.6 years, and male was 97 cases (57.7%). Concomitant procedures were 26 replacements of the ascending aorta (15.5%), 22 coronary artery bypass graftings (13.1%), 17 mitral valve surgeries (10.1%), 11 aortic root reimplantations (6.5%), and the others. Mean aortic clamping time was 123.6 ± 34.1 minutes. Postoperative mean AVA was 1.88 ± 0.43 (AVA/BSA: 1.22 ± 0.26), and peak/mean pressure gradient was 25.5 ± 15.8/12.1 ± 8.9 mm Hg. Thirty-day mortality was 6/168 (3.6%; myocardial infarction, lung injury, respiratory failure, acute heart failure, arrhythmia, and LOS). Overall survival rate was 75.3% at 5 years, and freedom from cardiac death was 89.7% at 5 years (mean follow-up period was 46.3 ± 31.2 months). Infective endocarditis (IE) occurred in 10 cases during the follow-up, and reoperation related to the neovalve was performed in 11 cases due to de novo AR in 7, de novo AS in 2, rupture of Valsalva’s sinus in 1, and pseudoaneurysm at the root in 1. Among those, TAVI was performed in one case with de novo AS. Freedom from reoperation rate was 93.5% at 5 years.

Conclusion: Aortic valve reconstruction using autologous pericardium can be applied to various types of aortic diseases and can be performed even with concomitant procedures. Postoperative aortic functions indicate potential advantage over the commercially available prosthetic valves, but this procedure may convey inherent susceptibility of the pericardium to IE and reoperation during follow-up.