Aortic Valve Repair for Severe Commissural Leaflet Defects Using Aortic Wall Patches

In patients with aortic insufficiency, annular dilatation often accompanies valve incompetence, necessitating annuloplasty. However, primary leaflet defects also are common, and when found unexpectedly at the time of planned repair, inadequate leaflet tissue often prompts prosthetic valve replacement. A method for achieving stable repair for severe leaflet deficiencies would be useful.

In this report, major leaflet defects due to ruptured large fenestrations were encountered in 2 patients, the first repaired with extensive plication, which failed. In the second patient, the defect was reconstructed using an autologous aortic wall patch. After geometric annuloplasty, the aortic wall strip was sutured with interrupted 6-0 sutures from the nodulus to the commissural top, with the intima facing coaptation. Leaflet free-edge length was adjusted to match the other normal leaflets at approximately reconstructed annular diameter x 1.5.

In the aortic wall patch patient, grade 4 preoperative aortic insufficiency fell to zero after repair, and the patient is doing well with continued excellent echo parameters at 1 year postoperatively.

As a leaflet substitute during aortic valve repair, aortic wall patches seem to provide an excellent solution to managing severe leaflet deficiencies.