[The Result of Aortic Valve Plasty with Autologous Pericardium Using Sawazaki's Template]

The autologous pericardial aortic valve repair technique developed by Ozaki et al., using glutaraldehyde-treated autologous pericardium, has demonstrated superior durability to bioprosthetic valves. However, this technique has certain limitations, including excessive cusp height and cusp fluttering due to leaflet redunduncy. These limitations can lead to coronary ostium obstruction during transcatheter aortic valve implantation (TAVI) and postoperative infectious endocarditis. Consequently, we used a modified aortic valve repair technique using a Sawazaki's cusp template with a reduced cusp height, approximately 8 mm lower than the original template. This modified template was used in 119 patients between 2012 and 2023, with a maximum follow-up of 11 years. The mean patient age was 74±6.5 years, with 41% being male. The operative mortality rate was 0.8%, with one death attributed to injury of the left main trunk during selective coronary cannulation. Recurrent aortic regurgitation was observed in 4 patients, primarily due to commissural detachment (2 patients) and bottom cusp dehiscence(1 patient). Therefore, the cusp template was enlarged by 1 mm, the bite size was increased, and small 2×2 mm square wings were added at both site of commissures to reinforce the structures. Three patients underwent aortic valve replacement, whereas 1 underwent TAVI. Notably, no cases of infective endocarditis were observed. The mean postoperative pressure gradient was 16.2±7.9 mmHg and the 11-year reoperation-free survival rate was 95.8%. In conclusion, the autologous pericardial aortic valve repair technique using the Sawazaki's porcine cusp template resulted in excellent and favorable long-term outcomes.