Mid- term Results after Aortic Valve Neocuspidization

Objectives Aortic valve neocuspidization (AVNeo) with autologous pericardium is gaining increasing attention as surgical treatment option for aortic valve disease. However, little is known about midterm durability and valve related events. Methods Patients undergoing AVNeo between 2016 to 2021 were included. Transthoracic echo was performed prior to the operation, at discharge and annually thereafter. Data were analyzed for incidences of structural valve deterioration, bioprosthetic valve failure, survival, freedom from reoperation and hemodynamic performance. Results 162 patients underwent AVNeo (mean age 52.6 ± 16.6 years; range: 13 – 78 years), 114 (70.4%) were male. 132 patients presented with a bicuspid aortic valve (81.5%) and 126 with aortic valve stenosis (77.8%). Concomitant procedures were performed in 63 patients (38.9%). Mean follow- up was 3.5 ± 1.2 years. At discharge, peak and mean pressure gradients were 15.6 ± 7.2 and 8.4 ± 3.7 mmHg, respectively, with a mean EOA of 2.4 ± 0.8 cm2 and after 5 years 14.5 ± 4.6 and 7.5 ± 2.2 mmHg and 2.3 ± 0.8 cm2. At 5 years, cumulative incidence of moderate and severe structural valve deterioration and bioprosthetic valve failure were 9.82%±3.87, 6.96%±3.71% and 12.1%±4.12%, respectively. Survival was 97.3%±1.4% and freedom from reoperation 91.3%±2.4. Conclusion AVNeo accomplishes low pressure gradients early after initial surgery and during follow- up. Survival in this young patient population is excellent. The main reason for reoperation is endocarditis while rates for structural valve degeneration are low.