Objectives: The search for optimal patch material for aortic valve reconstruction (AVR) is an
ongoing challenge. In this study, we report our initial experience of AVR in congenital
heart surgery (CHS) using decellularized bovine pericardial patch material.
Methods: Data of 40 consecutive patients who underwent AVR with decellularized bovine pericardial
patch between February 2014 and August 2016 were retrospectively reviewed. Median
age at operation was 9 (2–34) years, 18 patients were younger than 7 years. 26 patients
presented initially with aortic valve insufficiency (AI) and 14 with stenosis (AS).
Clinical and echocardiographic data were available until August 2017 for a median
postoperative follow-up (FU) of 20 (0.1–39) months.
Results: Nine of 40 patients (23%) suffered from an event during FU (death: n = 1, 2.5%; reoperation: n = 8, 20%). Overall, the probability of freedom from re-operation/death was 100%,
89% ± 6% and 56% ± 12% at median 10, 20 and 30 months FU, respectively. Reason for
re-operation was stenosis in 3 patients (8%), insufficiency in 4 patients (10%) and
1 patient (2.5%) was diagnosed with aortic valve endocarditis. Of the remaining 31
patients, 2 patients are scheduled for re-operation (AS: n = 1, AI: n = 1) and 9 patients show worsening of aortic valve function with moderate AI. Freedom
from developing combined endpoint (death/re-operation/moderate degree of aortic valve
dysfunction (AS, AI)) after AVR was 97% ± 2.5%, 73% ± 8%, and 33% ± 9% at 10, 20,
and 30 months, respectively. On multivariate testing including the following parameters:
age at operation, cardiopulmonary bypass time, pre-operative aortic annulus z-score,
AS or AI as primary diagnoses and type of reconstruction (bicuspid, tricuspid), no
association for reoperation/death and worsening of aortic valve function could be
found.
Conclusion: AVR using decellularized bovine pericardial patch material in patients with congenital
aortic valve disease show poor results already at 30 months FU.
