Transesophageal Evaluation of Reconstructive Surgery for Aortic Valve Stenosis

BACKGROUND: With transesophageal echocardiography (TEE), were evaluated morphological characteristics and early hemodynamic parameters of stentless three leaflets pericardial patch in patients with aortic stenosis (AS) undergoing aortic valve (AV) surgery. AIM: The aim of the study was to point the importance of two-dimensional and three-dimensional TEE imaging intra and early postoperatively. METHODS: At Zan Mitrev Clinic, 2002–2020, were included 377 patients following the actual guidelines of European Society of Cardiology for valvular disease, whereas patients with dilatation of aortic annulus, rheumatoid arthritis, and chronic program on hemodialysis were excluded from the study. Instead of using a standard prosthesis, we made a reconstructive surgery implanting three new created leaflets using bovine/equine pericardium by replacing destroyed valve cusps. Leaflets were implanted separately, using continuous sutures with two supported stitches and that is how real stentless AV without any stent or sowing ring was created. Intraoperative and post-operative TEE was performed. RESULTS: 377 pts with aortic valvular disease (211–56% male, and 166–44% female; 82–21, 75% with AS, 32–8, 49% with aortic insufficiency, and 263–69, 76% with combined stenosis and insufficiency) were included in the study. Post-operative TEE showed aortic morphology close to normal AV, average pressure gradient was 8 mmHg. 121 pts got a combination with aortocoronary bypass (2.3 grafts per pts). 4 patients were re-operated. Mortality rate was 12.46% (44 pts). Follow-up period was 18 years. CONCLUSIONS: Real stentless aortic bioprosthesis is with a close morphology and hemodynamic parameters as a normal valve. TEE such as tool for assessment of AV morphology, anatomy of aortic root, pre-, and intra-operative plays a pivotal role in guiding case selection, surgical planning, and in evaluating procedural success.