Aortic valve neocuspidization in patients under 65 years old

Objective: We aimed to elucidate the surgical outcomes of aortic valve neocuspidization (AVNeo) in patients under 65 years old. Methods: From December 2010 to February 2019, we performed AVNeo in a total of 168 patients. Of them, we evaluated 36 patients aged under 65 years. Twenty-three patients had aortic regurgitation (AR) and 13 had aortic stenosis (AS). There were 20 patients who had isolated AVNeo, and the concomitant procedures were coronary artery bypass grafting in 5, mitral valve procedures in 4, ascending aorta replacement in 4, MAZE in 3, closure of atrial septum defect in 1, and tricuspid valve annuloplasty in 1. In the AS series, preoperative echocardiography revealed an average peak pressure gradient of 81 ± 33 mmHg. In the AR series, preoperative echocardiography revealed 15 patients with severe AR and 8 patients with moderate-severe AR. Results: There were no conversions to valve replacement. There were two in-hospital deaths owing to low output syndrome and sepsis in the emergent cases. In the AS series, postoperative echocardiography showed an average peak pressure gradient of 23 ± 15 mmHg 1 week post-procedure and 19 ± 9 mmHg 26 months post-procedure. In the AR series, postoperative echocardiography revealed no AR in 11, trivial in 9, and moderate in 1. Three patients underwent reoperation. The freedom from reoperation rates were 100% and 93% at 36 and 60 months of follow-up, respectively. Conclusions: AVNeo in patients aged under 65 years appears to be suitable considering its early and midterm outcomes. Verification and follow-up of its long-term outcomes and reliability are indispensable.