Objective: The surgical treatment of malformed semilunar valves in congenital heart defects is challenging in terms of providing both longevity and the potencial to grow with the recipient. We investigated a new surgical technique of Trileaflet Semilunar Valve Reconstruction (AVaTAR) in an acute porcine model, a technique with geometrical properties that could remain sufficient and allow with some growth with the child.
Methods: An acute 60-kg porcine model was used. With echocardiography, baseline pulmonary valvular geometry and hemodynamics were investigated. On cardiopulmonary bypass, the pulmonary leaflets were explanted, and the new procedure was performed with customized homograft-treated pericardial neo-leaflets. Off bypass, hemodynamics was reassessed.
Results: Twelve animals were investigated. The neo-valves were found sufficient in ten animals and with minimal regurgitation in two animals. The neo- valve had a peak gradient of 3 ± 2 mm Hg with a peak velocity of 0.8 ± 0.2 m/s. The coaptation in the neo-valve had a mean increase of 4 ± 3 mm, P < .001.
Figure: Coaptation in the native and the neo-valve. The neo-valves had increased coaptation, a feature that would help to accommodate to the patient's growth.
The neo-valve had a windmill shape in the echocardiographic short-axis view, and the neo-leaflets billowed at the annular plane in the long-axis view, two more important features that contribute to the ability of the neo-valve to accommodate to the child's growth.
Figure: Echocardiographic images with direct probe placement long-axis view of the (A) native pulmonary valve and the (B) neo-valve and direct probe placement short-axis view of the (C) native
pulmonary valve and the (D) neo-valve.
Conclusions: In this acute porcine model, the neo-valve had no clinically significant regurgitation or stenosis. The neo-valve had an increased coaptation, a windmill shape, and leaflets that billowed at the annular plane. These geometric findings may allow for sustained sufficiency as the annular and pulmonary artery dimension increase with the child's growth. Further long- term studies should be performed to evaluate the efficacy and the growth potential.
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