Aortic valve neocuspidization using autologous pericardium is an anticoagulant-free surgical alternative for aortic valve disease, but data on its short- and mid-term durability remain limited.

This study includes all patients who underwent aortic neocuspidization between November 2018 and January 2025 in two centers. Analyses focused on structural valve degeneration, survival, reoperations, and hemodynamic performance assessed by echocardiographic measurements preoperatively, at discharge, and annually thereafter.

Fifty-three patients underwent surgery (mean age 40±20 years, range 7–74 years), including 15 minors (28%) and 39 males (76%). Among them, 26 (49%) had a unicuspid valve, 21 (39%) bicuspid, 5 (10%) tricuspid, and 1 (2%) quadricuspid. Aortic stenosis was present in 30 patients (56%) and severe aortic regurgitation in 23 (44%). Concomitant procedures were performed in 17 patients (32%). The mean follow-up was 2.0±1.4 years. At hospital discharge, the peak and mean pressure gradients were 13±8mmHg and 8±5mmHg, respectively. At the end of follow-up, the peak and mean pressure gradients were 13±10mmHg and 7±5mmHg, respectively, and 96% of patients had less than grade 2 aortic regurgitation (Fig. 1). Two reinterventions were necessary: an early failure in a 39-year-old patient due to aortic leakage requiring a Ross procedure at 48hours, and a cusp perforation at 2.9 years in a 47-year-old patient, resulting in the only death in the cohort.

Aortic neocuspidization provides low pressure gradients and the absence of significant regurgitation both immediately after surgery and at mid-term follow-up. The survival of young patients is excellent, suggesting that this approach may delay the need for a Ross procedure.