Reconstruction of the Dysfunctional Bicuspid Aortic Valve and a New Method for Aortic Valve Replacement

Objectives: Reconstruction of the aortic valve regained interest also in pediatric population. This report presents different reconstruction techniques as well as a new method for aortic valve replacement using autologous non-treated pericardium.

Methods: Between July 2010 and March 2017, twenty-eight patients with dysfunctional bicuspid aortic valve have been operated on. The median age was 5.5 years (limits 1 day to 26 years) (21% < 1 month); 8 patients (28.6%) had a previous balloon dilatation. The procedures performed were commissurotomy and shaving (13 patients; 46.4%), partial leaflet replacement and neocommissure creation (5 patients; 17.8%), leaflet extension and neocommissure creation (4 patients, 14.3%), leaflet replacement and leaflet shaving (1 patient; 3.6%), new method for aortic valve replacement using autologous pericardium (5 patients; 17.8%) with bicuspid (3 patients) and tricuspid (2 patients) configuration.

Results: There was neither early nor late mortality. The median follow-up is 2.5 years (limits 0.16–7 Years). Postoperative, 14 patients (50%) have no aortic regurgitation (AR), 7 patients (25%) have trivial AR, 6 patients (21.4%) have mild AR. Only 1 patient has moderate AR. Two patients requires reintervention (mechanical aortic valve replacement 1 year after aortic valve reconstruction in the only patient with postoperative moderate AR, leaflet replacement and leaflet shaving seven years after commissurotomy and shaving in another patient).

Conclusion: Different surgical procedures are required for the reconstruction of the dysfunctional bicuspid aortic valve. The new method for aortic valve replacement using autologous non-treated pericardium is reproducible and allows a bicuspid as well as a tricuspid configuration of the new created aortic valve. The growth potential is preserved and the medium-term results are durable.