ONE-POINT ADVICE: Creating a Morphological Template for Autologous Pericardial Cusps
Many cardiovascular surgeons have by now attempted aortic valve replacement using autologous pericardium, although the only documented long-term outcomes involve the Duran method  described by Al Halees et al.  (Fig. 27.1). As shown in Fig. 27.1, the glutaraldehyde-treated autologous pericardium is trimmed and used to create the aortic valve. Their outcomes for 65 subjects with a mean follow-up period of 10.5 years and up to 16 years revealed that endocarditis had occurred in seven subjects (10.8%), which was relatively frequent. However, if we exclude endocarditis, then the freedom from structural valve deterioration (SVD) was 80 ± 5% at 10 years and 58 ± 9% at 15 years. These valves therefore do not compare favorably to prosthetic valves. However, when we consider that these outcomes are from 30 years ago, when echocardiography was in its infancy, we believe that surgical outcomes could further be enhanced by improving surgical precision.