Background-Reconstruction of the regurgitant bicuspid aortic valve has been performed for Ͼ10 years, but there is limited information on long-term results. We analyzed our results to determine the predictors of suboptimal outcome. November 1995 and December 2008, 316 patients (age, 49Ϯ14 years; male, 268) underwent reconstruction of a regurgitant bicuspid aortic valve. Intraoperative assessment included extent of fusion, root dimensions, circumferential orientation of the 2 normal commissures (Ͼ160°, Յ160°), and effective height after repair. Cusp pathology was treated by central plication (nϭ277), triangular resection (nϭ138), or pericardial patch (nϭ94). Root dilatation was treated by subcommissural plication (nϭ100), root remodeling (nϭ122), or valve reimplantation (nϭ2). All patients were followed up echocardiographically (cumulative follow-up, 1253 years; mean, 4Ϯ3.1 years). Clinical and morphological parameters were analyzed for correlation with 10-year freedom from reoperation with the Cox proportional hazards model. Hospital mortality was 0.63%; survival was 92% at 10 years. Freedom from reoperation at 5 and 10 years was 88% and 81%; freedom from valve replacement, 95% and 84%. Methods and Results-Between

Spinal cord injury after stented elephant trunk deployment might be related to occlusion of the excessive intercostal arteries or thromboembolism. Patients with a history of abdominal aortic aneurysm repair who require extensive deployment of the stented elephant trunk seem to be at a higher risk for spinal cord injury.

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Long-term stability of valve-preserving aortic root replacement was influenced not by the technique of root repair but by the preoperative aortic root geometry and postoperative cusp configuration.

Preservation of the bicuspid aortic valve is feasible in many patients. Long-term stability of the repaired valves is good; the negative impact of a dilated atrioventricular junction can be reduced by suture annuloplasty.

Background-Residual/recurrent mitral valve regurgitation is observed in 30% after undersized ring annuloplasty (RING) for ischemic mitral regurgitation (IMR). RING addresses primarily annular dilatation but does not correct severe leaflet tethering attributable to papillary muscle (PM) displacement. We proposed adjunctive PM repositioning under transesophageal echocardiography (TEE) guidance in the loaded beating heart using a transventricular suture (STRING). Methods and Results-Patients with tenting height Ն10 mm were identified as high-risk patients for repair failure. In these patients (nϭ30, age 68Ϯ11 years, ejection fraction 37Ϯ14%), RING (partial, median 29 mm) was combined with the adjunctive STRING-technique. A Teflon-pledgeted 3-0-polytetrafluoroethylene-suture was anchored in the posterior PM via horizontal aortotomy, exteriorized through the aorto-mitral continuity, and tied in the loaded beating heart under TEE guidance.

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Root remodeling continues to be a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve geometry, reproducible restoration of aortic valve function can be achieved with good long term durability.