Aortic Valve Reconstruction of Unicuspid Aortic Valve by Tricuspidization Using Autologous Pericardium

Background. Unicuspid aortic valve is a rare anatomic variant, but patients may require intervention for severe valve dysfunction at a young age. We introduce a new reconstructive technique for diseased unicuspid valve by tricuspidization with glutaraldehyde-treated autologous pericardium. Methods. From April 2007 through January 2011, we performed 304 cases of aortic valve reconstruction using glutaraldehyde-treated autologous pericardium. During the same period, we encountered 9 patients with unicuspid aortic valve, including 8 male patients and 1 female patient. Mean age was 48.9 +/- 19.9 years (14-78 years). Two patients had aortic stenosis (AS), 1 had aortic regurgitation (AR), and 6 patients had both. Our original aortic valve reconstruction technique is characterized by the independent replacement of 3 leaflets with separate measurement of length between each commissure. In the case of a unicuspid aortic valve, we create a new commissure at a higher point along the raphe at the same level with the 1 normally existing commissure. Results. No early mortality or major morbidity was recorded. Postoperative echocardiography showed trivial or no AR, with the peak pressure gradients averaging 10.6 +/- 3.3 mm Hg. One-year follow-up echocardiography revealed that the peak pressure gradients averaged 8.6 +/- 3.7 mm Hg, with trivial or no AR. The mean follow-up period was 551.1 +/- 51.4 days. All 9 patients are in good condition. No reoperation or any additional intervention has been necessary. Conclusions. Diseased unicuspid aortic valves were treated by our original aortic valve reconstruction technique with excellent early results. We continue to study the long-term results.