Pulmonary Valve Replacement Using an Intraoperatively Created Trileaflet Autologous Pericardial Valve: A Case Series

TL;DR

This case series describes a new surgical technique for creating a custom pulmonary valve using a patient's own pericardium, showing promising short- to mid-term results.

Contribution

A novel intraoperative method for constructing a trileaflet autologous pericardial pulmonary valve is introduced and evaluated.

Findings

The AAA valve showed none to moderate regurgitation in all patients during follow-up.

All patients had less than moderate stenosis except one, with MRI confirming mild leaflet motion restriction in that case.

Anatomic valve parameters were within acceptable ranges, suggesting good structural performance.

Abstract

Pulmonary valve replacement is inevitable for the majority of patients with long-standing pulmonary regurgitation. The purpose of this study was to describe the experience of employing a novel technique to create an intraoperatively handmade trileaflet pulmonary valve with glutaraldehyde-treated autologous pericardium (the AAA valve).

This case series study was conducted from September 2018 to March 2021 at Shiraz University of Medical Sciences, Shiraz, Iran. The surgical technique involved harvesting and treating with glutaraldehyde of the pericardium, constructing a trileaflet valve by encapsulating the pericardium within a Dacron tube with a diameter of 22 mm and a length of 20 mm, and implanting it into the pulmonary valve position.

The AAA valve was constructed for 10 patients with a mean age of 16.20±5.81 years, seven of whom had undergone surgery for tetralogy of Fallot. The patients’ mean follow-up length was 32.30±13.64 months. The AAA valve regurgitation was none to moderate. At the time of follow-up, all patients had AAA valve stenosis that was less than moderate, except for one case. Cardiac magnetic resonance imaging and echocardiography results confirmed mild leaflet motion restriction in the patient with moderate stenosis. The anatomic valve parameters in MRI revealed a mean geometric height, coaptation height, and effective height of 20.23±2.40 mm, 10.42±1.67 mm, and 14.34±2.24 mm, respectively. One patient died from non-cardiac causes.

The surgical establishment of a native pericardial valve in the pulmonary valve position yielded satisfactory short-term to midterm results and might be considered a viable alternative to the available options.

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