Results of Aortic Valve-Sparing and Restoration With Autologous Pericardial Leaflet Extensions in Congenital Heart Disease Jonah Odim, MD, PhD, MBA,

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Presentation transcript:

Results of Aortic Valve-Sparing and Restoration With Autologous Pericardial Leaflet Extensions in Congenital Heart Disease Jonah Odim, MD, PhD, MBA, Hillel Laks, MD, Vivek Allada, MD, John Child, MD, Stacy Wilson, BS, David Gjertson, PhD The Annals of Thoracic Surgery Volume 80, Issue 2, Pages 647-654 (August 2005) DOI: 10.1016/j.athoracsur.2005.03.060 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Conversion of bicuspid aortic valve to tricuspid configuration and cusp augmentation with autologous pericardial leaflet extensions. The median raphe of the conjoined cusp is incised from the free edge up to the annulus. The fibrotic, stiff, and rolled-up free edges are thinned back to pliable tissue. Glutaraldehyde-treated autologous pericardial extensions are sewn to the native free-edges with a running polypropylene suture up to the aortic wall. The suture line is continued up the aortic wall (full thickness) to just below the sinotubular junction. The pericardial leaflet extensions are secured to one another over a pericardial pledget on the outside of the aorta. This creates neo-commissures just below the sinotubular junction (bold arrows at top) and a taller interleaflet triangle creating optimal zone of coaptation. The hinge point of the valve (arrows below) remains in the pliable native cusp remnant ensuring flexibility and valve function in the event of leaflet extension fibrosis or calcification. Dilated and aneurysmal sinuses of valsalva are excluded from the remodeled aortic root with glutaraldehyde-treated pericardial lining. It is typical for relative dilation of the noncoronary sinus; however with connective tissue disorders all three sinuses may be involved and are excluded with pericardial lining to prevent further dilation, rupture, or dissection. Sinuses harboring coronary arteries require pericardial button removal overlying the ostia. The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Fusion of noncoronary and right coronary cusps to form conjoined leaflet with doming of the bicuspid aortic valve (upper panel). Trileaflet valve conversion with autologous pericardial leaflet extensions with classic “Mercedes Benz” sign in cross-section and resolution of valve doming (lower panel). (ASC. AORTA = ascending aorta; LA = left atrium; LCA = left coronary artery; LV = left ventricle; RA = right atrium.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Freedom from valve-related reoperation. (AVR = aortic valve repair; CHD = congenital heart disease; post-OP = postoperative.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Freedom from valve-related reoperation after repair (age, < 19 years). (AVR = aortic valve repair; post-OP = postoperative.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Impact or restoration of trileaflet semilunar configuration. (AVR = aortic valve repair; post-OP = postoperative.) The Annals of Thoracic Surgery 2005 80, 647-654DOI: (10.1016/j.athoracsur.2005.03.060) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions