Understanding the aortic regurgitation mechanism – patient screening for valve reconstruction

Abstract OBJECTIVES Different methods of aortic valve repair have been described in the literature for aortic regurgitation (AR) associated with doubly committed subarterial ventricular septal defects. Our goal was to present our experience with aortic valve reconstruction of a single leaflet using the aortic valve neocuspidization technique in this subset of patients. METHODS It is a retrospective review of 7 patients with doubly committed subarterial ventricular septal defects with significant (>moderate) AR who underwent the single-leaflet neocuspidization technique of aortic valve reconstruction from January 2016 to January 2019. Data were collected from medical records. All patients had thorough 2-dimensional echocardiographic assessment preoperatively and during the follow-up period. Primary end points were freedom from postoperative AR and freedom from reoperation and all-cause mortality within the follow-up period with secondary end points of freedom from thromboembolism and infective endocarditis. RESULTS Out of 7 patients, 6 were male and 1 was female. There were no perioperative deaths. The mean follow-up period was 2.6 ± 0.8 years. No deaths occurred during the follow-up period. At the latest follow-up examination, only 2 patients showed mild AR and were asymptomatic. There was no documented event of infective endocarditis or thromboembolism during the follow-up period. CONCLUSIONS The aortic leaflet neocuspidization procedure for the aortic valve is a relatively new concept. Availability of a template makes it an easily reproducible valve repair in paediatric patients with a single-leaflet abnormality. This technique preserves the remaining 2 normal leaflets, thus promoting the growth potential while maintaining near normal aortic root complex dynamics.

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Reconstruction of aortic valve by autologous pericardium (Ozaki’s procedure): Single center experience in Vietnam

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320981468 ◽

2020 ◽

pp. 021849232098146

Author(s):

Hung Thanh Ngo ◽

Huu Cong Nguyen ◽

Thuy Tran Nguyen ◽

Thanh Ngoc Le ◽

Lionel Camilleri ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Regurgitation ◽

Aortic Valve Area ◽

Pressure Gradients ◽

Autologous Pericardium ◽

Single Center Experience ◽

Mean Pressure ◽

Valve Reconstruction

Aim We aimed to report the experience of aortic valve reconstruction with autologous pericardium using Ozaki’s procedure in Vietnam. Methods The study included consecutive patients with isolated aortic valve disease who underwent Ozaki’s procedure in our hospital between June 2017 and August 2019. Aortic valve leaflets were reconstructed with autologous pericardium using Ozaki’s procedure. Results Sixty-one patients were included (mean age 55.8 years; 41 were male): 24 with aortic stenosis, 17 with aortic regurgitation, and 20 with both. Of the 61 patients, 16 had a bicuspid aortic valve, and 5 had infective endocarditis. The preoperative peak and mean gradient pressure gradients were 91.7 ± 16.1 mm Hg and 55.3 ± 10.3 mm Hg, respectively. Surgery was performed via a full or partial sternotomy. The procedure was successful in 59 cases. Two patients were converted to prosthetic valve replacement. The aortic crossclamp time was 110.9 ± 20.5 minutes. Intraoperative transesophageal echocardiography showed a mean pressure gradient of 8 ± 2 mm Hg and an aortic valve area of 3.04 ± 0.44 cm2. The mean follow-up period was 18.5 ± 5.7 months. One patient died in hospital due to cardiac tamponade. One patient underwent reoperation due to infective endocarditis 6 months after surgery. Another died at 8 months after surgery due to a mediastinal abscess. The surviving patients had no aortic regurgitation or mild aortic regurgitation at the last follow-up visits. Conclusions Aortic valve reconstruction with autologous pericardium provided good outcomes in our study.

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