Trileaflet Aortic Valve Reconstruction Using Bovine Pericardium

For several years now, trileaflet aortic valve reconstruction has been performed in patients with various aortic valve diseases. This study aimed to explore the feasibility and durability of trileaflet aortic valve reconstruction with bovine pericardium.

Trileaflet aortic valve reconstruction with bovine pericardium was performed in 519 patients with various aortic valve diseases from April 2008 to December 2019. The results for all 519 patients were reviewed retrospectively. Mean age was 48.04±19.08 years (range, 13-80 years), and 40 patients were younger than 18 years of age. Thirty-four (34) patients had aortic stenosis, 344 patients had aortic regurgitation, and 141 patients had both aortic stenosis and regurgitation. One hundred and fifty-four (154) patients had bicuspid aortic valves, and three patients had quadricuspid aortic valves. The size of the pericardial leaflets was designed to be individually proportional to the size of the aortic root.

Mean length of follow-up was 41.97±22.68 years (range, 1-127 months). In total, 448 patients were reviewed, and the follow-up rate was 86.4%. All procedures were successful without conversion to prosthetic valve replacement during the procedure. Six (6) patients died after the procedure (in-hospital mortality, 1.2%). All-cause mortality occurred in 11 patients during the follow-up period. The 10-year cumulative survival rate was 94.7%±2.9%. Redo aortic valve surgery was performed in 11 patients after the procedure. The actuarial freedom from redo aortic valve surgery after the procedure was 88.2%±5.2%. At the end of the follow-up, the mean peak was 29.1±9.6 mmHg and mean gradient was 15.6±6.2 mmHg.

The mid- and long-term outcomes in patients with various aortic valve diseases undergoing trileaflet aortic valve reconstruction with bovine pericardium are encouraging. The engineered pericardial leaflets should be individually proportional to the size of the aortic root.