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Aortic valve construction using pericardial tissue: short-term single-centre outcomes.

Fanar Mourad1, Sharaf-Eldin Shehada1, Juri Lubarski1

  • 1Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, Essen, Germany.

Interactive Cardiovascular and Thoracic Surgery
|August 17, 2018
PubMed
Summary

Modified pericardial aortic valve construction using custom templates offers a viable alternative for middle-aged patients with aortic valve disease. This technique ensures precise sizing and commissure implantation, leading to favorable early outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Biomaterials in Medicine
  • Cardiac Valve Repair

Background:

  • Aortic valve construction with pericardial tissue has a history dating back to the 1960s.
  • The procedure was notably re-introduced in 2010 and is utilized for specific aortic valve pathologies.
  • Precise sizing of neo-cusps and accurate commissure insertion are critical for procedural success.

Purpose of the Study:

  • To evaluate the clinical experience with modified custom-made templates for aortic valve construction using pericardial tissue.
  • To assess the early outcomes and feasibility of this technique in a cohort of patients.

Main Methods:

  • A prospective single-centre study involving 52 consecutive patients from September 2015 to March 2017.
  • Patients received either autologous (30.8%) or tissue-engineered pericardium (69.2%) for aortic valve construction.
  • A modified sizing technique utilizing custom-designed templates was employed, with follow-up including echocardiography.

Main Results:

  • The study included 52 patients (mean age 60±14 years; 63.5% male), with most presenting with aortic stenosis (65.4%).
  • Early outcomes included one stroke, two patients requiring dialysis, and one death.
  • Follow-up (mean 11.2±4.8 months) showed trace aortic regurgitation in 4 patients, a mean pressure gradient of 6.8±2.9 mmHg, three late non-cardiac deaths, and five reoperations for endocarditis.

Conclusions:

  • Aortic valve construction with pericardial tissue is a potential alternative for middle-aged patients with aortic valve disease unsuitable for repair.
  • The developed templates facilitate exact neo-cusp sizing and optimal commissure implantation.
  • Long-term data from larger cohorts are necessary to confirm the durability of these neo-valves.