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Pericardial patch augmentation for repair of incompetent bicuspid aortic valves at midterm

Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Theodor Stern Kai 7, 60599 Frankfurt am Main, Germany

Received 15 September 2007; received in revised form 30 January 2008; accepted 31 January 2008.

^_* Corresponding author. Tel.: +49 69 6301 6141; fax: +49 69 6301 5849. (Email: mirkodoss{at}aol.com).

Objective: Reoperation rates after repair of bicuspid aortic valves are higher than for mitral valve reconstruction. Satisfactory results have been reported for patch augmentation for tricuspid aortic valves. We have applied this technique for the repair of bicuspid aortic valves. Methods: Autologous pericardium is sutured to the free edge of the prolapsing bicuspid leaflet. A large coaptation surface is created and competence of the bicuspid valve is achieved. Forty patients underwent reconstruction of their bicuspid aortic valves by pericardial patch augmentation. Patients were followed up at regular intervals by echocardiography in yearly intervals. Results: There were no perioperative deaths. One year postoperatively, one patient died due to endocarditis. Seven patients (17.5%) had aortic regurgitation grade I, and the other 33 patients had non or trivial aortic regurgitation at discharge. At 4.2 ± 3.1 years postoperatively, only four patients (10%) had aortic regurgitation grade I. There were no cases of progression of regurgitation. Planimetric effective orifice areas ranged above 2 cm². Mean aortic gradients dropped from 8.2 ± 4.8 mmHg at discharge to 3.8 ± 3 at four years and the mean height of coaptation surface from 14.7 ± 2 mm to 12.3 ± 4, respectively. Conclusions: The pericardial patch augmentation technique increases coaptation surface, and thus provides reliable early and midterm competence of reconstructed bicuspid aortic valves.

Key Words: Aortic • Valve • Repair • Midterm • Follow-up