Templates of flat pericardial patterns for precise aortic cusp extension

Area of Science:

• Cardiovascular Surgery
• Biomaterials in Medicine
• Surgical Innovation

Background:

• Aortic cusp extension is currently a subjective and operator-dependent surgical technique.
• Significant retraction of aortic cusps can lead to severe aortic valve insufficiency.
• Standardized methods are needed to improve the precision and reproducibility of aortic cusp extension procedures.

Purpose of the Study:

• To develop novel templates for creating precise pericardial patches for aortic cusp extension.
• To evaluate the efficacy and safety of these templates in surgical correction of aortic valve insufficiency.

Main Methods:

• Templates were designed as 2D unwraps of natural aortic cusp geometry for various sizes.
• Bovine pericardial sheets were cut using these templates to create cusp extension patches.
• The technique was applied in two patients with retracted noncoronary aortic cusps and severe aortic valve insufficiency.

Main Results:

• Geometrically accurate aortic cusp extensions were achieved without complications.
• Intraoperative transesophageal echocardiography confirmed satisfactory aortic valve repair with minimal insufficiency (<1+) and low gradients.
• Early follow-up echocardiography showed cusps meeting at similar heights with identical excursions.

Conclusions:

• The developed templates enable precise cutting of pericardial sheets into accurate cusp extension patches.
• Initial clinical application demonstrates the utility of these templates for precise aortic cusp extension.
• This technique effectively restores aortic valve competence in patients with retracted cusps.