Aortic leaflet remodeling for the repair of congenitally malformed aortic valve

Aortic valve repair techniques are still evolving with better understanding of aortic root and leaflet imaging. This study seeks to present the results of an additional new technique in aortic valve repair of patients with congenital heart disease. The technique entails remodeling of the leaflet by intentional peeling of the myxomatous tissue to remodel the thickened leaflets (from the ventricular side of the aortic valve along with thinning and plication of the central region of the leaflets). Other repair techniques are added to complete the repair.

We performed a retrospective chart analysis of 19 patients who underwent aortic valve remodeling for aortic regurgitation and received advanced imaging preoperative assessment from January 2022 to February 2024. Institutional Review Board approval was obtained under expedited review for retrospective studies.

All patients with a wide range of congenital pathologies underwent leaflet remodeling; 9 patients (47%) underwent additional valve-sparing root replacement, and 6 patients (32%) received subaortic annuloplasty. Fifteen patients (79%) had moderate or severe aortic insufficiency at the time of presentation. Mean clinical follow-up was 10 months (range, 1.9-31). At follow-up, 7 patients did not have aortic regurgitation on echocardiogram, and the remaining 12 patients had mild regurgitation. None of the patients had more than mild regurgitation. All patients assessed for left ventricular ejection fraction at follow-up had an ejection fraction greater than 50%. None of the patients required reoperation.

Leaflet remodeling by intentional peeling of myxomatous tissue expands leaflet dimensions by freeing tethered portions and improves mobility and coaptation. This additional technique will preserve more valves from replacement. However, further follow-up is needed.