Autologous Pericardium for Trileaflet Aortic Valve Reconstruction Reveals Excellent Early Hemodynamic Results

Introduction: Trileaflet aortic valve reconstruction using autologous pericardium preserves annular flexibility with nearly physiological hemodynamic performance. Additionally, immanent drawbacks of prosthetic valve replacement like foreign material, xenograft tissue degeneration, patient prosthesis mismatch and anticoagulation can potentially be avoided. Here, we present clinical outcome and hemodynamic performance in a series of 38 patients, operated between 10/2016 and 8/2017.

Methods: Mean age was 58.4 ± 15.5 years, 23 patients (60.5%) were male. Leading pathology was aortic stenosis in 31 (81.6%) and insufficiency (AI) in 7 (18.4%) patients. Pericardium was harvested, fixed in 0.6% glutaraldehyde for 10 minutes and rinsed in saline for 3 × 6 minutes. Commercially available sizers and templates served for cusp measurement. Trileaflet reconstruction was performed in all cases regardless if the native valve was tri- or bicuspid. Every patient underwent transthoracic echo (TTE) prior to the operation and at discharge and transesophageal echo (TEE) before and after cardiopulmonary bypass (CPB).

Results: Mean CPB/cross-clamp time was 162.9 ± 22.6/134.9 ± 16.9 minute. Mean annulus size was 24.1 ± 7.9 mm. Intraoperatively, peak and mean pressure gradients were 17.4 ± 11.3 and 8.9 ± 5.5 mm Hg and no patient had residual AI. Before discharge, TTE showed no or only mild AI in 36 patients (94.7%) with peak and mean pressure gradients of 18.1 ± 7.9 and 9.9 ± 4 mm Hg, respectively. Mean effective orifice area (EOA) was 2 ± 0.7 cm², mean effective orifice area index (EOAI) 1.1 ± 0.4. We observed no or only moderate patient-prosthesis mismatch in 92% of patients. Only three patients exhibited severe patient-prosthesis mismatch. Two patients (5.3%) underwent prosthetic aortic valve replacement due to early recurrent moderate to severe AI within the same hospital stay.

Conclusion: Our initial experience using autologous pericardium for trileaflet aortic valve reconstruction reveals excellent hemodynamic results in terms of pressure gradients, EOA and PPM.