Aortic Valve Reconstruction of Unicuspid Aortic Valve by Tricuspidization Using Autologous Pericardium

• Published in: The Annals of thoracic surgery Vol. 94; no. 4; pp. 1180 - 1184
• Main Authors: Kawase, Isamu, MD, Ozaki, Shigeyuki, MD, PhD, Yamashita, Hiromasa, MD, Uchida, Shin, MD, Nozawa, Yukinari, MD, Matsuyama, Takayoshi, MD, Takatoh, Mikio, MD, Hagiwara, So, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Valve - abnormalities; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - congenital; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Cardiothoracic Surgery; Echocardiography; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Pericardium - transplantation; Pneumology; Reconstructive Surgical Procedures - methods; Retrospective Studies; Surgery; Transplantation, Autologous; Treatment Outcome; Young Adult; 35; Reconstruction; Anesthesia; Autologous system; Circulatory system; Cardiology; Aortic valve; Pericardium
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.05.016

Background Unicuspid aortic valve is a rare anatomic variant, but patients may require intervention for severe valve dysfunction at a young age. We introduce a new reconstructive technique for diseased unicuspid valve by tricuspidization with glutaraldehyde-treated autologous pericardium. Methods From April 2007 through January 2011, we performed 304 cases of aortic valve reconstruction using glutaraldehyde-treated autologous pericardium. During the same period, we encountered 9 patients with unicuspid aortic valve, including 8 male patients and 1 female patient. Mean age was 48.9 ± 19.9 years (14–78 years). Two patients had aortic stenosis (AS), 1 had aortic regurgitation (AR), and 6 patients had both. Our original aortic valve reconstruction technique is characterized by the independent replacement of 3 leaflets with separate measurement of length between each commissure. In the case of a unicuspid aortic valve, we create a new commissure at a higher point along the raphe at the same level with the 1 normally existing commissure. Results No early mortality or major morbidity was recorded. Postoperative echocardiography showed trivial or no AR, with the peak pressure gradients averaging 10.6 ± 3.3 mm Hg. One-year follow-up echocardiography revealed that the peak pressure gradients averaged 8.6 ± 3.7 mm Hg, with trivial or no AR. The mean follow-up period was 551.1 ± 51.4 days. All 9 patients are in good condition. No reoperation or any additional intervention has been necessary. Conclusions Diseased unicuspid aortic valves were treated by our original aortic valve reconstruction technique with excellent early results. We continue to study the long-term results.