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Updated: May 14, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Right Atrial Appendage for Aortic Valve Reconstruction.

Paighton C Miller1, Jacob R Miller2, Chelsea T Mannie2

  • 1Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri.

The Annals of Thoracic Surgery
|April 11, 2025
PubMed
Summary
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Live atrial appendage tissue shows promise for reconstructing aortic valves in pediatric patients with congenital heart defects. This novel approach offers a potential new option for aortic valve interventions, with early results indicating feasibility and good short-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomaterials in Medicine

Background:

  • Congenital aortic valve disease, frequently bicuspid, presents challenges due to limitations of current repair tissues.
  • Existing techniques like valve replacement or pericardium use are suboptimal, lacking ideal tissue properties.
  • Prior success with right atrial appendage (RAA) tissue for pulmonary valve reconstruction informed this study.

Purpose of the Study:

  • To evaluate the preliminary results of using live RAA tissue for aortic valve reconstruction.
  • To assess the feasibility and early outcomes of this novel technique in pediatric patients.

Main Methods:

  • Six pediatric patients with unicuspid or bicuspid aortic valves and significant insufficiency underwent RAA tissue reconstruction.

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Last Updated: May 14, 2025

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  • RAA tissue was primarily used to replace the deficient right coronary leaflet.
  • External annuloplasty was performed for annular stabilization, with echocardiography used for evaluation.

    • Main Results:

    • The reconstructive procedure was successfully performed in all six patients (ages 7-18).
    • All patients were extubated in the OR with an uncomplicated hospital stay (4-8 days).
    • Follow-up (5-34 months) showed trivial to mild central aortic insufficiency in five patients and mild to moderate basal insufficiency in one.

    Conclusions:

    • Live atrial tissue demonstrates functional capacity in the aortic position.
    • This technique presents a potential new option for aortic valve interventions in select pediatric cases.
    • Long-term efficacy and durability of RAA tissue for aortic valve repair require further investigation.