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Clinical Outcomes and Echocardiological Hemodynamics of the Aortic Valve Reconstruction using Autologous Pericardial Leaflet - Comparison With the Bioprosthesis Valves -
Keisuke Watadani, Taijiro Sueda, Katsuhiko Imai, Tatsuya Kurosaki, Taiichi Takasaki, Sinya Takahashi, Keijiro Katayama, Takahiro Tguchi.
Hiroshima University of Medicine, Hiroshima, Japan.

OBJECTIVE: In Aortic valve replacement, small size valve have a problem of higher postoperative pressure gradient and lower rehabilitation. Compared to Anglo-Saxon, Japanese patients were used smaller size valve. Bioprosthesis valve implantation is the preferred choice for AVR in the elderly as a result of the shorter life expectancy and reduced need of anticoagulation. However, despite the progress of the design and construction of prosthetic valves, hemodynamic performance is not yet comparable to that of native aortic valve. We performed aortic vale reconstruction (AVrC) using glutaraldehyde-treated autologous pericardium with Ozaki's developed sizing apparatus and template. This is the first time to report the clinical outcomes and echocardiological hemodynamics of AVrC compared with the bioprosthesis valve.
METHODS: The study group consisted of 79 patients with aortic stenosis who underwent elective AVR with a bioprosthesis or autologous pericardial at Hiroshima University Hospital between January 2008 and May 2013. Of them 47 were treated with a CEP bioprosthesis (Edwards Lifescience, Irvine, CA, USA) and 10 with an autologous pericardial leaflet.
RESULTS: In hospital death, all over survival rate and cardiac event free rate were not significant change in AVrC compared with bioprosthesis valve. Aortic valve peak flow and LV-aortic mean pressure gradient at after 6 months were significantly lower in AVR group (p≤0.01). In AVrC group, aortic valve annular size at discharge was not significant change surging 1 cycle. But at after 6 months and 1 year, annular size changing rate was significant larger compared with discharge (p<0.001).
CONCLUSIONS: AVrC provides good short and mid term echocardiological hemodynamics compared with bioprosthesis valve. Assessment of long-term data will be examined in the future.

Echocardiography at pre and postoperative
Max Ao flow (m/s)AVrC (n=10)Bioprosthesis (n=47)p=
at Discharge2.90±0.742.57±0.490.034
after 6 months2.20±0.072.60±0.66<0.001
after 1 year2.23±0.612.68±0.430.735
Mean LVAo-PG (mmHg)
at Discharge19.11±9.5114.93±5.920.053
after 6 months9.20±1.4816.10±6.910.001
after 1 year13.75±10.2515.71±5.440.224

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