Results of Pericardial Patches in Tricuspid and Bicuspid Aortic Cusp Repair

Background. Aortic valve repair for aortic regurgitation has become an increasingly accepted alternative to replacement. Some cusp pathologies require partial cusp replacement or augmentation using pericardium. There are limited data on pericardial patch durability. We analyzed our long-term results with pericardial patches in aortic cusp repair to clarify whether durability is influenced by aortic valve morphology or underlying cusp pathology. Methods. From 2000 to 2017, 275 patients (mean age, 53 +/- 14 years) underwent aortic valve repair involving pericardial patches with tricuspid aortic valve (n = 139, 50.5%) or bicuspid aortic valve (n = 136, 49.5%) morphology. Pericardial patches were used for either central cusp replacement (n = 64, 23%), closure of defects (n = 55, 20%), fenestrations (n = 104, 38%), cusp augmentation (n = 27, 10%), or commissural reconstruction (n = 25, 9%). Follow-up was complete in 96%. Results. Ten-year survival was 85%, and 10-year freedom from reoperation was 53%. Durability was inferior after bicuspid aortic valve repair (37%) compared with tricuspid aortic valve repair (69%; P< .0001). Best 10-year freedom from reoperation was found after closure of fenestrations (73%) and defects (67%). Suboptimal durability was observed after cusp augmentation (44%), central cusp replacement (39%), and commissural reconstruction (16%, P< .001). Conclusions. The results of aortic cusp repair using pericardium depend on valve morphology and cusp pathology. Mid- and long-term durability is reasonable in tricuspid aortic valve repair. In bicuspid aortic valve repair valve stability is poor regardless of cusp pathology and repair technique. For any analysis of patch durability, details of pathology and technique have to be considered. (C) 2020 by The Society of Thoracic Surgeons