Objective: Interest in aortic valve neocuspidization (AVNeo) is gaining widespread traction globally. This study aims to evaluate the clinical feasibility and long-term outcomes of AVNeo using glutaraldehyde-treated autologous pericardium, based on a single-center experience spanning nine years.

Methods: Over 200 AVNeo procedures were performed between June 2016 and July 2025. Clinical data were prospectively collected and retrospectively reviewed to assess surgical success and patient outcomes.

Results: The majority of patients were over 60 years old, and over 85% underwent surgery for aortic stenosis. The mean age was $64.1 \pm 9.7$ years (range: 18–82). Aortic regurgitation was the primary diagnosis in 21 patients. The mean surgical annular diameter was $20.9 \pm 0.26$ mm, and a bicuspid valve was identified in 25 patients (13.2%). A minimum 12-month follow-up was completed for 146 patients (range: 1 month to nearly 8 years). No cases required conversion to prosthetic valve replacement, and trileaflet reconstruction was achieved in all patients. The mean cross-clamp time was $106 \pm 19$ minutes. Postoperative echocardiography demonstrated significant hemodynamic improvement, with average peak and mean pressure gradients of $11.2 \pm 5.6$ mmHg and $6.0 \pm 3.5$ mmHg, respectively. There were 16 post-discharge mortalities, with few attributed to cardiac causes. Four patients required reoperation.

Conclusion: AVNeo is a feasible and reproducible procedure yielding excellent clinical results. Hemodynamically, AVNeo produces low postoperative pressure gradients, a large effective orifice area (EOA), and minimal aortic regurgitation.

Zviad Bakhutashvili is cardiac surgeon with over 30 years of experience in cardiac surgery. His work focuses on advancing surgical techniques, particularly in valve reconstruction, minimally invasive procedures, redo surgery, ascending and aortic arch surgery and coronary artery bypass surgery on a beating heart. He has performed over 6,500 surgeries and pioneered several innovations in Georgian and Eastern European cardiothoracic surgery. As a professor and director of the cardiac surgery residency program at Tbilisi State Medical University, he is dedicated to training the next generation of surgeons. His mission has always been to improve patient outcomes, contribute to medical research, and develop new surgical methods that benefit both my patients and the global medical community.

Surgical Expertise and Innovations

·  First CABG in Georgia – 1993

·  Supervised over 10,000 cardiovascular procedures and performed more than 6,500 personally.

·  Over 13 years of experience in minimally invasive cardiac procedures, including mini-thoracotomy and mini-sternotomy approaches.

·  Extensive specialization in thoracic aortic surgery and complex valve reconstruction techniques.

·  An internationally recognized expert and proctor in AVNeo (Ozaki) aortic valve reconstruction.

·  Authored over 35 peer-reviewed scientific publications in cardiovascular medicine

·  Published case reports and research on valve-sparing techniques, arterial grafting, and AVNeo techniques.