Hemodynamic and Angiographie Late Results Following Enlargement of Narrow Aortic Root Using Autologous Pericardium in Prosthetic Aortic Valve Replacement

Abstract

From 1976 to 1984, 31 patients underwent enlargement of very small aortic roots using autologous pericardial strips the subannular part of which extended into the incised anterior mitral valve leaflet. The majority of these interventions (n = 24) were carried out before the end of 1980. Over an average follow-up period of 52.5 months, only one of the surviving patients had a complication traceable to the pericardial implantation (aneurysmatic patch dilatation), and 2 late deaths were also not directly connected with the type of surgical procedure. Objective findings for evaluating the hemodynamic status and behavior of the patch material were attained in a total of 14 patients by heart catheterization and angiography. Eleven patients were examined twice at an average of 2.5 months, and 11 at an average of 52.5 months. Eight of latter patients had undergone an early postoperative investigation. The hemodynamic results after prosthetic valve replacement and aortic annulus enlargement was satisfactory in those examined. No evidence could be found in any patient of disturbance of the mitral valve's function, paravalvular leakage at the aortic prosthesis, or obstruction of the left ventricular outflow tract caused by this operative technique. Progressive patch dilatation which had already been proved at the first examination was observed in one case. These results verify not only the efficiency of this technique for the enlargement of a small aortic root in the frame of prosthetic valve replacement, but especially the suitability of autologous pericardium as patch material for this purpose.

Aneurysm formation of pericardial patch in Manouguian procedure

“…An AV patient–prosthesis mismatch with first generation prosthetic heart valves were more common than new generations of prosthetic heart valves with greater effective orifice area, but it may still perform aortoplasty to prevent patient–prosthesis mismatch. One of the most used aortoplasty surgeries is the Manouguian procedure [4]. Using pericardial patch in this procedure has become more common which has been associated with more late complications, such as patch aneurysm, aortic dissection, paraaortic leakage, MV insufficiency [4], and endocarditis [3], [4].…”

“…One of the most used aortoplasty surgeries is the Manouguian procedure [4]. Using pericardial patch in this procedure has become more common which has been associated with more late complications, such as patch aneurysm, aortic dissection, paraaortic leakage, MV insufficiency [4], and endocarditis [3], [4].…”

“…From two reports of patch aneurysm in the literature, the first one reported a case of aneurysm formation 69 months after surgery out of 31 patients undergoing AV replacement associated with Manouguian aortoplasty [4]. The second study is a case report of aortic root pericardial patch aneurysm formation 20 years after valve implantation, which progressed in size after 5 years.…”

“…Therefore, using pericardium became more common because of availability, pliability, resistance to infection, and nonimmunogenicity [2]. Cardiac surgeons utilized it to repair different cardiac defects with satisfactory results, but long-term complications and outcomes remain unclear [3] as its implantation has been reported to be challenging for aortic repair [4]. There have been few reports regarding aneurysm development in pericardial patch [2], [4]; however, the proper management and prevention of such a complication is evolving.…”

Successful implantation of a decellularized equine pericardial patch into the systemic circulation

“…Mirsadraee et al [35] was able to show significantly lower calcium levels in fresh/frozen pericardia compared with glutaraldehyde-fixed pericardia, 117 mg/g versus 332 μg/g Ca 2+ , respectively, of tissue dry weight (p<0.001). Other studies showed the fate of using autogenic pericardia, even in the systemic circulation [36,37]. …”