Aortic valve neocuspidization with autologous Pericardium using Sizers and Templates: Short-Term outcomes

  • S. V. Varbanets Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • O. S. Gurjeva Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • A. S. Kosiura Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • G. I. Yemets Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
  • I. M. Yemets Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
Keywords: aortic valve, aortic regurgitation, aortic valve reconstruction, autologous pericardium

Abstract

Background. Despite certain disadvantages of aortic valve replacement (AVR) using biological prosthesis, e.g. valve degeneration and non-optimal haemodynamic properties, it’s becoming more popular in patients of different age groups. The use of autologous pericardium for aortic valve (AV) reconstruction could be a reasonable alternative to AVR and may provide slower degeneration of neo-AV due to the absence of patient-prosthesis immune reaction as well as optimization of haemodymanics resulting from preservation of normal physiology of aortic root.

Objective. To study the opportunities of AV reconstruction in children and in adults with autologous tissues using different techniques and to evaluate short-term outcomes of surgical treatment.

Methods. From 01/2015 to 06/2019 we have performed AV reconstruction with autologous pericardium in 50 patients with AV disease. Of these, 18% (n = 9) were children from 6 to 18 years of age. Three methods of AV reconstruction were applied: 1) AV reconstruction with solid autopericardial patch (n = 1); 2) AV reconstruction with separate autopericardial leaflets without use of sizers (n = 3); 3) AV reconstruction with separate autopericardial leaflets using sizers and templates (n = 46). Reusable resterilizable sizers and corresponding templates were constructed according to the formulas proposed by W. Gasparyan and manufactured as a sample set by Med-Service Ltd, Kyiv, Ukraine. In 39 patients (84.78%) we have used Ozaki leaflet implantation technique.

Results. There were no fatal cases during the observation period. In 94% of patients (n = 47), good outcomes of AV reconstruction were observed: AV was competent in 74% (n = 37) of patients, aortic regurgitation (AR) was trivial in 12% (n = 6) of cases, and 8% (n = 4) of patients had mild AR on discharge. It should be noted that in 2 of 47 patients moderate AR was diagnosed and successfully corrected intraoperatively after reclamping of aorta. Three patients (6%) with bicuspid AV anatomy were diagnosed with moderate or severe AR which required reoperation during the same hospitalization. In one case AR was corrected by means of repeated reconstruction. In two other cases AV valve was replaced with mechanical prosthesis.

Conclusions. AV neocuspidization with autologous pericardium is a safe procedure which demonstrates good short-term outcomes. The use of originally produced set of sizers and templates developed according to W. Gasparyan’s formula in combination with Ozaki technique of leaflets implantation simplify the procedure, are time-saving and improve reproduc-ibility of the operation performed.

References

  1. Aupart MR, Sirinelli AL, Diemont FF, Meurisse YA, Dreyfus XB, Marchand MA. The last generation of pericardial valves in the aortic position: ten-year follow-up in 589 patients. Ann Thorac Surg. 1996;61:615–20. https://doi.org/10.1016/0003-4975(95)00953-1
  2. Banbury MK, Cosgrove DM, Lytle BW, Smedira NG, Sabik JF, Saunders CR. Long-term results of the Carpentier-Edwards pericardial aortic valve: a 12-year follow-up. Ann Thorac Surg. 1998;66:S73–6.
  3. Grabenwoger M, Fitzal F, Gross C, Hutschala D, Bock P, Brucke P, et al. Different modes of degeneration in autologous and heterologous heart valve prostheses. J Heart Valve Dis. 2000;9:104–9.
  4. Mohammadi S, Baillot R, Voisine P, Mathieu P, Dagenais F. Structural deterioration of the Freestyle aortic valve: mode of presentation and mechanisms. J Thorac Cardiovasc Surg. 2006;132:401–6. https://doi.org/10.1016/j.jtcvs.2006.03.056
  5. Butany J, Zhou T, Leong SW, Cunningham KS, Thangaroopan M, Jeggatheeswaran A, et al. Inflammation and infection in nine surgically explanted Medtronic Freestyle stentless aortic valves. Cardiovasc Pathol. 2007;16(5):258–67. https://doi.org/10.1016/j.carpath.2007.01.009
  6. Human P, Zilla P. The possible role of immune responses in bioprosthetic heart valve failure. J Heart Valve Dis. 2001;10:460–6.
  7. Konakci K, Bohle B, Blumer R, Hoetzenecker W, Roth G, Moser B, et al. Alpha-Gal on bioprostheses: xenograft immune response in cardiac surgery. Eur J Clin Invest. 2005;35:17–23. https://doi.org/10.1111/j.1365-2362.2005.01441.x
  8. Siddiqui RF, Abraham JR, Butany J. Bioprosthetic heart valves: modes of failure. Histopathology. 2009;55:135–44. https://doi.org/10.1111/j.1365-2559.2008.03190.x
  9. Al Halees Z, Al Shahid M, Al Sanei A, Sallehuddin A, Duran C. Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothorac Surg. 2005 Aug;28(2):200–5; discussion 205. https://doi.org/10.1016/j.ejcts.2005.04.041
  10. Chan KM, Rahman-Haley S, Mittal TK, Gavino JA, Dreyfus GD. Truly stentless autologous pericardial aortic valve replacement: An alternative to standard aortic valve replacement. J Thorac Cardiovasc Surg. 2011 Jan;141(1):276–83. https://doi.org/10.1016/j.jtcvs.2010.09.038
  11. Mercer JL, Benedicty M, Bahnson HT. The geometry and construction of the aortic leaflet. J Thorac Cardiovasc Surg. 1973;65:511–8.
  12. Swanson M, Clark RE. Dimensions and geometric relationships of the human aortic valve as a function of pressure. Circ Res. 1974;35:871–82. https://doi.org/10.1161/01.res.35.6.871
  13. Silver MA, Roberts WC. Detailed anatomy of the normally functioning aortic valve in hearts of normal and increased weight. Am J Cardiol. 1985;55:454–61. https://doi.org/10.1016/0002-9149(85)90393-5
  14. Gasparyan VC. Method of determination of aortic valve parameters for its reconstruction with autopericardium: An experimental study. J Thorac Cardiovasc Surg. 2000;119:386–7.
  15. Duran CMG, Gometza B, Kumar N, Gallo R, Martin-Duran R. Aortic valve replacement with freehand autologous pericardium. J Thorac Cardiovasc Surg. 1995;110:511–6. https://doi.org/10.1016/S0022-5223(95)70248-2
  16. Cheng A, Dagum P, Miller DG. Aortic root dynamics and surgery: from craft to science. Philos Trans R Soc Lond B Biol Sci. 2007;362:1407–19. https://doi.org/10.1098/rstb.2007.2124
  17. Rodriguez F, Green G, Dagum P, Nistral JF, Harrington KB, Daughters GT, et al. Left ventricular volume shifts and aortic root expansion during isovolumic contraction. J Heart Valve Dis. 2006;15:465–73.
  18. Lansac E, Lim HS, Shomura Y, Lim KH, Rice NT, Goetz W, et al. A four-dimensional study of the aortic root dynamics. Eur J Cardiothorac Surg. 2002 Oct;22(4):497–503. https://doi.org/10.1016/s1010-7940(02)00405-0
  19. Thubrikar MJ, Deck JD, Aouad J, Nolan SP. Role of mechanical stress in calcification of aortic bioprosthetic valves. J Thorac Cardiovasc Surg. 1983;86:115–25.
  20. Ozaki S, Kawase I, Yamashita H, Uchida S, Takatoh M, Kiyohara N. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg. 2018 Jun;155(6):2379–87. https://doi.org/10.1016/j.jtcvs.2018.01.087
  21. Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, Geva T. Recommendations for Quantification Methods During the Performance of a Pediatric Echocardiogram: A Report From the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010 May;23(5):465–95; quiz 576–7. https://doi.org/10.1016/j.echo.2010.03.019
  22. Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007 Jan;28(2):230–68. https://doi.org/10.1093/eurheartj/ehl428
  23. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, et al. Guidelines on the management of valvular heart disease (version 2012). European Heart Journal. 2012;33:2451–96. https://doi.org/10.1093/eurheartj/ehs109
  24. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. 2017;38:2739–91. https://doi.org/10.1093/eurheartj/ehx391
  25. Hassanein M, Zayed A. Early Experience in Aortic Valve Reconstruction with Autologous Pericardium for Aortic Valve Insufficiency. J Cardiovascular Thoracic Surgery. 2017;2(3):1–4. https://doi.org/10.15226/2573-864X/2/3/00118
Published
2019-09-16
How to Cite
Varbanets, S. V., Gurjeva, O. S., Kosiura, A. S., Yemets, G. I., & Yemets, I. M. (2019). Aortic valve neocuspidization with autologous Pericardium using Sizers and Templates: Short-Term outcomes. Ukrainian Journal of Cardiovascular Surgery, (3 (36), 71-77. https://doi.org/10.30702/ujcvs/19.36/14(071-077)
Section
NEW TREATMENTS FOR CARDIOVASCULAR DISEASES