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Method of Total Autologous Reconstruction of the Aortic Valve

Wednesday, December 17, 2014

This experimental video shows a total reconstruction of the aortic valve with autologous pericardium using the author’s method of patch tailoring. In this method, the three inter-commissural distances are measured after the native valve excision, and the parameters are determined using the author’s formulas (1). The single patch is tailored with all three leaflets nearby. The patch is sutured on the fibrous annulus using continuous running sutures. The newly created aortic valve is tested with hydrostatic pressure.

References:
1. Gasparyan, V. Method of determination of aortic valve parameters for its reconstruction with autopericardium: An experimental study. JTCVS, 2000; 119: 386-387.

Comments

Thanks Dr. Varshney. There is no specific technique of treating/handling of the pericardium, just the same routine method of fixation (0,625% glutaraldehyde solution for 10 min).
Kudos to Dr Gasparyan for a finely demonstrated technique. I would like to know the long-term results of surgical series employing the said technique of aortic valve reconstruction. Thanks!
Total autologous reconstruction of aortic valve was first offered by Dr. Carlos Duran early in 1995. He used the special molds of different sizes depending on the aortic root diameter to tailor the patch. He performed about 50 cases in Saudi Arabia with Dr. Al Halees and his team. Later they reported in European Journal of Cardiothoracic Surgery very good long-term (up to 16 years) follow up results . This inspired many other surgeons to start doing this procedure. Dr. Sh. Ozaki from Tokyo just recently reported his more than 400 patients experience of this operation using his own method (Asian Cardiovascular and Thoracic Annals October 2014 22: 903-908), but still with molds. He reported very good mid-term results. Other surgeons from different countries (USA, Germany, Switzerland etc.) also perform this type of aortic valve reconstruction still using mold. So, we can conclude that total autologous reconstruction of aortic valve is quite widely used now all over the world with very acceptable mid-term and long-term results and I am sure the interest toward this operation will increase further. I am sure this will become a GOLD STANDARD in Aortic Valve Surgery in the near future. This is a stentless, autologous valve - a very good alternative for the prosthetic valves (especially mechanical) and Ross operation!!! Can be something better? NO. This is a real revolution in aortic valve surgery! The only problem is to have a simple, precise, reproducible and universal method for intra-operative tailoring of the pericardial patch without need of any templates and mold. I think that my method is the one that we need.
Excellent video well done and fantastic technique. The other point to make about long term results is that any problems arising in the leaflets in the future could be dealt with with a TAVI prosthesis that would be bigger than a valve in valve
Excellent video well done and fantastic technique. The other point to make about long term results is that any problems arising in the leaflets in the future could be dealt with with a TAVI prosthesis that would be bigger than a valve in valve
Thanks Dr. Briffa. As I said already in my previous comment the long term durability of the autologous pericardial valve is well proven. Also I am sure there should not be any problem with TAVI prosthesis in the future since this is a stentless autologous valve, just similar to the patient native valve! So, I am sure any problem arising in the leaflets in the future could be easily dealt with a TAVI prosthesis.
Congratulations, I fully stand with this technique and Dr Gasparyan statements. It has been previously quoted that one of structural failure modes of autologous pericardium is fissures or ruptures at the free margins of the neo-leaflets. We have previously highlighted the importance of Arantius Nodulus in Stress Deceasing according to the Laplace Law: J Heart Valve Dis. 2005 Jul;14(4):565-6. The Arantius nodule: a 'stress-decreasing effect'. Aazami MH, Salehi M That s maybe a reason for very good results obtained by Schaefers Central Plication Suture. I hope incorporating such a central plication suture in autologous pericardium will even enhance the long term results. Cordially
Thanks very much Dr. Haazami. Yes, I fully agree that Arantius Nodule are very important for stress release. Really central plication suture may simulate such nodule and create "stress-decreasing effect".

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