Excellent Hemodynamic Performance After Aortic Valve Neocuspidization Using Autologous Pericardium.

Krane, Markus; Boehm, Johannes; Prinzing, Anatol; Ziegelmüller, Johannes; Holfeld, Johannes; Lange, Rüdiger

doi:10.1016/j.athoracsur.2020.04.108

journal article

Title:: Excellent Hemodynamic Performance After Aortic Valve Neocuspidization Using Autologous Pericardium.
Document type:: Journal Article
Author(s):: Krane, Markus; Boehm, Johannes; Prinzing, Anatol; Ziegelmüller, Johannes; Holfeld, Johannes; Lange, Rüdiger
Abstract:: BACKGROUND: Aortic valve neocuspidization (AVNeo) for trileaflet aortic valve reconstruction using autologous pericardium (Ozaki procedure) offers an alternative treatment modality to overcome drawbacks of conventional prosthetic aortic valve replacement. METHODS: Between October 2016 and April 2019, 103 patients underwent surgery. Mean follow-up was 426 ± 270 days. Aortic stenosis was the leading diagnosis in 80 patients (77.7%) and aortic regurgitation in 23 (22.3%), respectively. Mean age was 54.0 ± 16.4 years (range, 13.8-78.5). A bicuspid valve was found in 81 patients (78.6%). Transthoracic echocardiography was performed at discharge and at 6 to 12 months after surgery. During AVNeo surgery valve sizing for an Abbott/St Jude Trifecta bioprosthesis (virtually implanted Trifecta bioprosthesis; St Jude Medical, St Paul, MN) was performed to compare pressure gradients and effective orifice area with published data. RESULTS: Trileaflet aortic valve reconstruction was achieved in all patients. In 38 patients neocommissures were created (36.9%). Mean cross-clamp time was 135 ± 20 minutes. Four patients underwent reoperation; the overall freedom from reoperation was 96.1%. Echocardiographic 6- to 12-months follow-up after surgery was available in 93.8% of patients and did not show any change in hemodynamic parameters compared with discharge. Comparison between AVNeo and virtually implanted Trifecta Bioprosthesis revealed a significantly lower mean pressure gradient (8.5 ± 3.7 mm Hg vs 10.2 ± 2.0 mm Hg, P < .001) and higher mean effective orifice area (2.2 ± 0.7 cm2 vs 2.1 ± 0.4 cm2, P = .037) for AVNeo. CONCLUSIONS: AVNeo shows low reoperation rates after surgery within the first 2 years. The hemodynamic performance is excellent, and the effective orifice area and mean pressure gradient remain stable within the first year.
Journal title abbreviation:: Ann Thorac Surg
Year:: 2021
Journal volume:: 111
Journal issue:: 1
Pages contribution:: 126-133
Fulltext / DOI:: doi:10.1016/j.athoracsur.2020.04.108
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/32540439
Print-ISSN:: 0003-4975
TUM Institution:: Klinik für Herz- und Gefäßchirurgie (Prof. Lange)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)2021