Aortic Valve Reconstruction with Autologous Pericardium in Children

Sadahiro Sai, Satoshi Matsuo, Naoki Masaki

Miyagi Childrens Hospital, Sendai, Japan

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–B

Abstract

Objectives

Effectiveness of aortic valve reconstruction using autologous pericardium (AVRP) in adults has been often reported as alternative option for prosthetic valve replacement although its durability and technical reproducibility are still unknown. Indication of this procedure for children raises our concern because it is potentially capable of delaying aortic valve replacement or Ross procedure. We sought surgical outcome of this procedure in children suffering aortic valve disease.

Methods

Between January 2013 and March 2017, four AVRP were performed for three aortic insufficiency and one stenosis patients. Mean age and weight were 9.1y (5-12) and 26.8kg (17.9-31.6). Three of them had bileaflet valve. Concomitant cardiac anomalies were VSD, Mitral insufficiency and coarctation in each one patient. In surgical procedure, autologous pericardium soaked with 0.625% Glutar-aldehyde solution for 5-6min was used. Cusp extension technique was applied for one patient, and cusp replacement method designed for trileaflet, by which “Rache” was divided as recognized the commissure point in bileaflet cases, were done for others.

Results

There was no mortality.  Mean follow up period was 2.1 year (0.8-4.2). Re-AVRP was done in one case due to progression of insufficiency after thirteen months. Aortic insufficiency level remained less than mild in other thee cases. Aortic valve velocity by ultrasound echocardiogram had been less than 2m/s in all cases during this study period. Left ventricular diastolic dimension improved from 126.9±32.1% of N to 98.0±23.3% of N postoperatively.

Conclusions

Early- and mid- term surgical outcome of aortic valve reconstruction using autologous pericardium was acceptable.

This procedure could be a promising option which may delay the timing of valve replacement or Ross procedure in pediatric patients with severe aortic stenosis and regurgitation while further investigation is warranted.