*2.4.1 Surgical homograft mitral valve replacement and aortic autopericardial neo-cuspidalization*

Instead of the mechanical double valve replacement, the autopericardial neocuspidization was opted for aortic valve procedure, while MA was chosen for mitral valve replacement. After the median sternotomy a pericardial flap was harvested with its subsequent preservation in 0.6% glutaraldehyde. Standard cardiopulmonary bypass and cold cardioplegia were applied. Intraoperative assessment revealed bicuspid aortic valve pathology with leaflet fibrosis. Mitral valve leaflets were also significantly thickened and were not considered for mitral repair. Three semilunar cusps of the same size were dissected from the pericardial flap. The aortic valve neocuspidization with autologous pericardium leaflets was performed. The autopericardium valve was formed (**Figure 7a**). The next step was mitral homograft implantation in the mitral position (**Figure 7b**). The mitral homograft papillary muscles were fixed to the LV papillary muscles with four U-shaped sutures using 4-0 sutures. The mitral homograft was placed into the LV cavity, then mitral homograft was fixed to the mitral annulus with continuous 5-0 polypropylene sutures (**Figure 7c**). The posterior mitral annulus was reinforced with soft band (**Figure 7d**). TEE and postoperative

*Clinical Implication of Cardiac Valve Allografts in Rare Surgical Circumstances DOI: http://dx.doi.org/10.5772/intechopen.112865*

#### **Figure 7.**

echocardiography showed improved function of aortic autopericardial neovalve and mitral homograft with only trivial regurgitation. The duration of cardio-pulmonary bypass (CPB) was 182 min, and the aortic cross-clamp duration was 155 min. The patient was discharged on the 14th day after surgery in satisfactory condition, with marked increase in physical tolerance and decreased dyspnea. Transthoracic echocardiography 1 year after the operation shows mild MA regurgitation with peak pressure gradient of 3 mmHg, mean pressure gradient of 2 mmHg, and trivial aortic regurgitation with peak pressure gradient of 8 mmHg, mean pressure gradient of 4 mmHg.
