New Aortic Valve Reconstruction Technique Utilizing Autologous Pericardial Leaflet For Aortic Stenosis

Yoshito Inoue, Soshu Kotani, Hirofumi Haida

Hiratsuka City Hospital , Hiratsuka, Kanagawa, Japan

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

[Purpose]

No ideal prosthesis is available for the patients with aortic stenosis (AS) with small aortic annulus. However, the creation of new autologous aortic pericardial leaflet (Aortic Valve Neo-cuspidization; Ozaki procedure) allows the full size restoration and the motion of their native annuli regardless of annular size.

[Methods]

The patients with small aortic annulus less than 20mm (mean 17.7± 2.5; n=50) were treated with Aortic Valve Neo-cuspidization between 2012-2017. Mean age was 75.2 ± 5.6 (Body Surface Area 1.47± 0.15, 15 men, 35 women). Preoperative max/mean transvalvular pressure gradient (PG) were 86.5 ± 38.7 and 51.4 ± 24.7 mmHg, aortic valve orifice area (AVA) was 0.69 ± 0.2 cm².

[Results]

Sufficient AVA were obtained without post-operative aortic insufficiency. Mean postoperative PG and AVA were 9.5 ± 6.6 mmHg、1.47 ± 0.4 cm² respectively. When Aortic Valve Neo-cuspidization was performed in cases with bicuspid aortic valve, tricuspidization was performed by creating neo-commissures. Mean cross-clamp time was 133.5 ± 19.9 min. Large coaptation length were created by the special valve sizing template (8-22mm). There has been no reoperation during follow up due to structural valve deterioration.

[Conclusions]

Aortic Valve Neo-cuspidization allows full size restoration as well as physiological movement of the native aortic valve annulus. Since there is no concern for the cost of prosthetic valve, PPM and anticoagulation, this technique provides an ideal option for AS with small aortic annulus.