Aortic valve Surgery: Types of Repair and Reconstruction

Aortic valve surgery is one of the commonly performed procedures in cardiac surgery across the world. As a alternative to the the standard approach of replacement of the aortic valve with prosthesis, either mechanical of bioprosthetic, interest in aortic valve repair has been there for over 20 years.

There are different kinds of repair for the aortic valve, most being for cases with leaking valves. Very few kinds of repair have been used for valve narrowing or stenosis. A large number of repairs utilized the patient’s own pericardium.

However, the rate of reoperation has been high, making this type of repair less than satisfactory. Its limited durability can be explained by imperfect preparation of the pericardium, the design of the pericardial cusps, and the technical performance of the operation. At the same time, commercially available tissue valves are also imperfect with limited durability and imperfect hemodynamics. The limited durability has become the major issue in younger patients and the imperfect hemodynamics has become the major issue in patients with small aortic roots

Recently, a new technique has become popular as one of the aortic valve reconstruction procedures. The procedure is Professor Ozaki’s work in Japan on an aortic cusp replacement technique using pericardial tissue. The procedure published in the prestigious Journal of Thoracic and Cardiovascular Surgery in 2014 shows very impressive outcomes in 404 consecutive patients with only two patients requiring reoperations because of infective endocarditis. The other 402 patients showed less than mild aortic regurgitation, and no thromboembolic events were recorded after a mean follow-up 23.7 +13.1 months. Freedom from reoperation was 96.2% at 53 months of follow-up. These short and medium term outcome data are as good as or better than those for standard replacement tissue valves regarding all variables, survival, freedom from reoperation, stroke and endocarditis.

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