Background: Aortic Valve Construction (AVC) was introduced by Ozaki in 2010. The precise sizing
of the new cusps, along with the placement of commissures, is considered the key to
success in this procedure. Our aim is to present our single-center experience with
modified AVC using self-made templates and tools.
Methods: We evaluated data from patients who underwent AVC at our institution between April
2018 and September 2023. Patient data were collected prospectively. All patients used
a modified sizing technique with specially designed templates and coaptation forceps.
Echocardiographic follow-up was conducted at discharge and annually thereafter. Primary
endpoints included Major Adverse Cardiac and Cerebrovascular Events (MACCE) and early
mortality. Secondary endpoints were freedom from re-operation and late mortality.
Results: A total of 129 patients underwent AVC during this period. The median age was 56 ± 12
years, with 94 (73%) being male. The majority of patients (96%) used autologous tissue
(123 patients) or tissue-engineered pericardium (TEP) (5 patients). AVC was performed
as an isolated procedure in 72 (56%) cases and as a combined procedure in 57 (44%)
cases. Bicuspid valves were predominant (70%). Seven patients (5.4%) had primary endocarditis.
The mean cardiopulmonary and cross-clamp times were 122 ± 31 and 88 ± 18 minutes,
respectively. In-hospital mortality occurred in 3 out of 129 (2.3%) patients in the
total cohort (merely 1 patient with isolated AVC (1.4%)). Two patients required temporary
dialysis, and none needed pacemaker implantation. A total of 5 patients (3.9%) required
re-operation. Four due to endocarditis at 27 days, 8 months, 9 months, and one year
postoperation and one patient underwent re-operation 2 months after the primary operation
due to early cusp tear (TEP). The postoperative mean gradients at 0/1/2 years were
4.7/5.4/5.9 mmHg, remaining stable. The mean follow-up period was 24.3 ± 4.6 months,
with only 5 patients developing mild aortic regurgitation during the follow-up. Three
patients developed thrombosis of one cusp (all with primary bicuspid valves, which
were subsequently switched to tricuspid valves), resolving after temporary anticoagulation
therapy. Finally, late mortality was reported in 2 patients, both unrelated to valve
issues.
Conclusion: Aortic valve construction is a feasible procedure that can provide a good alternative
for young patients, especially those with small aortic annuli. The newly designed
templates and forceps enable precise measuring and optimal commissure implantation.
