Pathologic findings in pericardium and native valve tissues after aortic valve-sparing with autologous pericardial leaflet extension

Background and aim of the study: Aortic valve repair with autologous pericardial leaflet extension is a valuable treatment option for aortic valve disease. The study aim was to examine and describe the histopathologic changes in native and pericardial extension leaflet tissues after this procedure. Methods: The pathologic findings of nine patients (mean age 26.7 ± 2.9 years; range: 0-77 years) who underwent aortic valve repair with autologous leaflet extension were analyzed. The initial diagnosis included: bicuspid aortic valve (n = 4), truncus arteriosus (n = 3), ventricular septal defect (n = 1) and subaortic stenosis (n = 1). The pathologic endpoints of the study were fibrosis, calcification and myxomatous changes, based on a scale from 0 to 3. Results: Fibrosis and calcification demonstrated similar grade results in the pericardial and native tissues; no statistical difference was observed (p = 0.261 and p = 0.999, respectively. Myxomatous degeneration was greater in the native tissue (p = 0.012). Among the native tissue group, five patients were graded 1 and three graded 3 for myxomatous degeneration. Among the pericardial tissue patients, six were graded 0, and one each were graded 1, 2, or 3. Conclusion: Following aortic valve repair with pericardial leaflet extension, both the pericardial and native valve tissue are susceptible to myxomatous degeneration, fibrosis, and calcification. Among the present patients, myxomatous degeneration was more often present in the native tissue, but there was no difference in calcification or fibrosis between the native and pericardial tissue groups.