Trileaflet aortic valve reconstruction using glutaraldehyde fixed autologous pericardium

Aortic valve replacement (AVR) has been considered the gold standard for surgical treatment of aortic stenosis (AS). However, the prostheses used for replacement are not perfect—with mechanical valve requiring anticoagulation and bioprosthetic valves having issues with durability. Recently, there have been an influx of reconstructive techniques. However, these techniques are underutilized due to the complexity of the technique. One of the techniques that has shown promising long-term results is the trileaflet aortic valve reconstruction using glutaraldehyde fixed autologous pericardium. Once the autologous pericardium is fixed in glutaraldehyde, the aortotomy is done. The leaflets of the diseased aortic valve are removed, along with any calcium along the annulus. The commissural distances are then measured using custom sizers which correspond to a template used to sketch out neo-leaflets. The three neo-leaflets are attached using a running 4-0 polypropylene sutures. Once the valve reconstruction is completed, coaptation of the three cusps is checked by using saline and negative pressure on the left ventricular vent. Once the aortotomy is closed and the patient comes off cardiopulmonary bypass, the integrity of the leaflets are once again checked by transesophageal echocardiography. This standardized technique offers excellent long-term results and is reproducible.