Aortic Leaflet Remodeling for the Repair of Congenitally Malformed Aortic Valve

Abstract

ObjectiveAortic valve repair techniques are still evolving with better understanding of aortic root and leaflet imaging. This study seeks to present results of an additional new technique in aortic valve repair of patients with congenital heart disease. The technique entails remodeling of the leaflet by intentional peeling of the myxomatous tissue to remodel the thickened leaflets (from the ventricular side of the aortic valve along with thinning and plication of the central region of the leaflets). Other repair techniques are added to complete the repair. MethodsA retrospective chart analysis of 19 patients that underwent aortic valve remodeling for aortic regurgitation and received advanced imaging pre-operative assessment from January 2022 to February 2024. Institutional review board approval was obtained under expedited review for retrospective studies. ResultsAll patients with a wide range of congenital pathologies, underwent leaflet remodeling, nine patients (47%) underwent additional valve-sparing root replacement and six (32%) had subaortic annuloplasty. Fifteen patients (79%) had either moderate or severe aortic insufficiency at the time of presentation. Mean clinical follow-up was 10 months (range: 1.9-31). (Table 1). At follow-up, 7 patients did not have aortic regurgitation on echocardiogram and the remaining 12 had mild regurgitation (Table 2). None of the patients had more than mild regurgitation. All patients assessed for LVEF at follow-up had their EF>50%. None of the patients required re-operation. ConclusionsLeaflet remodeling by intentional peeling of myxomatous tissue expands leaflet dimensions by freeing tethered portions and improves mobility and coaptation. This additional technique will preserve more valves from replacement. However, further follow up is needed.