Aortic Valve Reconstruction for Endocarditis Using Tissue-Engineered Bovine Pericardium

Originally presented as a Surgical Motion Picture at the 2015 STSA Annual Meeting

Objectives: Outcomes for surgical management of aortic valve endocarditis are still suboptimal and represent an excellent opportunity for quality improvement. Transitioning to aortic valve repair seems logical, but a recent effort involving limited autologous pericardial leaflet patching had a high failure/reoperation rate. The goal of this video is to illustrate complete pericardial leaflet replacement by the Ozaki method, using tissue-engineered bovine pericardium (CardioCel) as the leaflet substitute.

Methods: A 30-year-old man developed fever, new aortic insufficiency (AI), and positive blood cultures. After intravenous antibiotic therapy, the blood cultures cleared and aortic valve reconstruction was undertaken. The infection had caused thickening and defects in the fused leaflet of a Sievers Type 1 bicuspid valve, and the leaflets were not salvageable. After excision of the diseased cusps, 3 CardioCel leaflets were fashioned and sutured securely to the valve annulus, using Ozaki's technique. Good leaflet apposition was obtained.

Results: After discontinuing cardiopulmonary bypass, the reconstructed CardioCel leaflets moved well with complete competence, a coaptation height of greater than 1 cm, and a 7 mmHg mean systolic gradient. The patient recovered uneventfully with no complications. The patient remains asymptomatic with unchanged echo parameters and has returned to full work activity.

Conclusion: Complete pericardial leaflet replacement is a promising approach for treating aortic valve endocarditis because of minimal foreign body, inherent resistance to re-infection, excellent AI reduction, low gradients, secure annular fixation producing less recurrence, and no anticoagulation requirement. Tissue-engineered bovine pericardium (CardioCel) functions well and may extend durability by converting to host-compatible tissue. However, longer follow-up and more clinical experience will be required for full validation.

Dr. Mazzitelli, Dr. Schreiber, and Dr. Rankin are consultants for Admedus Ltd. 

Copyright 2015, used with permission from the Southern Thoracic Surgical Association. All rights reserved.