Early- to Mid-Term Results of Aortic Valve Neocuspidization for Rheumatic Aortic Valve Disease

Introduction:Recently, there has been a widespread use of aortic valve neocuspidization, but there is limited data regarding rheumatic heart disease.In this study, we reviewed our experience.Methods: A total of 33 patients (22 men, 66.7%) with rheumatic aortic valve disease (mean age 39.36 10.65 years) underwent aortic valve replacement between June 2019 and October 2023.Results: The most common pathology was severe stenosis (14 patients, 42.4%), with bicuspid morphology in 11 patients (33.3%).The mean cardiopulmonary bypass and aortic cross-clamping times were 151 24.26 and 127 21.05 minutes, respectively.There was no perioperative mortality.One patient who developed significant aortic regurgitation underwent valve replacement prior to discharge.The pre-discharge average peak/mean gradients were 12 3.7/6 2 mmHg, respectively.Follow-up was complete (mean: 31.54 12.94 months).There were two late mortalities (6%), one due to endocarditis and another due to coronavirus disease.One patient (3%) needed a permanent pacemaker one year later.Overall survival at one, two, and four years were 97%, 97%, and 94% respectively, and freedom from reoperation was consistent at 97%.The peak/mean gradients remained low at one and three years (12 2.7 mmHg/4.8 1.7 mmHg and 10.14 4.02/4.4 2.3 mmHg, respectively).Overall four-year freedom from at least moderate regurgitation was 97%. Conclusion:Our data shows promising results for this procedure in rheumatic pathology.The hemodynamic data is satisfactory and the early-to mid-term results are encouraging; however, long-term data is needed to determine durability.