Right Atrial Appendage for Aortic Valve Reconstruction

Congenital aortic valve disease, often bicuspid, is a common problem. Current repair techniques, including valve replacement or use of pericardium for repair, are imperfect and limited by lack of ideal tissue. Based on our experience using live right atrial appendage (RAA) tissue for pulmonary valve reconstruction, we describe preliminary results using this tissue for aortic valve reconstruction.

Six patients with unicuspid or bicuspid aortic valves and predominant aortic insufficiency were referred for intervention. Intraoperative assessment of the native valve was followed with reconstructive techniques, wherein RAA tissue was used predominantly to replace the retracted or missing right coronary leaflet. Concomitant annular stabilization with external annuloplasty was also performed. Preoperative and postoperative echocardiograms were evaluated with last follow-up reported.

Repair was performed in 6 patients (aged 7, 9, 10, 11, 14, and 18 years). Two had undergone balloon aortic valvuloplasty with reduction in gradient but increased insufficiency. Left ventricular, aortic annular, and ascending aortic dilation had developed in all patients. RAA tissue was used to recreate the right coronary cusp in all patients. All were extubated in the operating room and had an uncomplicated course, with a hospital length of stay of 4 to 8 days. At the last follow-up (5-34 months), trivial to mild central aortic insufficiency was noted in 5 patients and mild to moderate insufficiency at the leaflet base in 1.

These preliminary results suggest live atrial tissue can function in the aortic position, offering a possible new option for those requiring aortic valve interventions. Long-term results remain to be seen.