Autologous Pericardial Leaflet Replacement for Bicuspid Aortic Valve Endocarditis

Presented at the 2012 STS Annual Meeting

Purpose: Increasing the use of autologous valve repair holds promise for improving the results of aortic valve surgery. In endocarditis cases with only one leaflet destroyed, preserving the normal leaflets and replacing the destroyed leaflet with autologous pericardium could be especially useful, since long-term valve-related complications have been lower with valve reconstruction. This video illustrates three patients in whom this procedure was performed.

Methods: All three patients were fully treated with antibiotics preoperatively. Based on recent models of aortic valve geometry, the shapes and dimensions of individual leaflets could be derived, and were tested successfully in the animal laboratory for single leaflet replacement. Two of the three patients in this video had bicuspid aortic valve endocarditis with destroyed cusps, and the third had severe calcification of both leaflets, in addition. Autologous pericardium was harvested and treated with a 10-minute emersion in 0.6% gluteraldehyde at the operating table. Leaflets were fashioned from the pericardium according to the models, and then used to replace the destroyed cusps, employing a bi-leaflet repair.

Results: Autologous pericardial leaflet replacement as illustrated was a very straightforward procedure. All three patients had complete valve competence and low gradients postoperatively. Routine interval transesophageal echocardiograms have shown full competence of valve reconstructions and stable long-term results to two years postoperative.

Conclusion: Autologous pericardial replacement of single or multiple bicuspid aortic valve leaflets destroyed with endocarditis is feasible and straightforward. Because the long-term results of autologous pericardial leaflet replacement have been excellent, increased application of this procedure to patients with bicuspid endocarditis might be indicated.

Copyright 2012, used with permission from The Society of Thoracic Surgeons. All rights reserved.