Aortic valve repair in adult congenital heart disease

Abstract

Aortic valve repair in adult congenital heart disease (ACHD) went through a major development during the last two decades to become an increasingly established treatment option in experienced heart valve repair centers. This mini-review addresses valve-sparing treatment strategies in the two most common clinical entities of patients with adult congenital aortic valve disease, namely those presenting with bicuspid (BAV) and unicuspid (UAV) aortic valve disease. Both diseases are integral components of the continuum of congenital aortic valve diseases and represent one of the most common reasons of cardiovascular morbidity in young and otherwise healthy adult patients. The review will highlight the most important advantages of aortic valve sparing procedures as compared to the conventional valve replacement strategy. New treatment aspects will be reviewed including minimally-invasive surgical approaches for aortic valve repair as well as modern protocols of enhanced perioperative recovery which will potentially improve the perioperative recovery and quality of life of the patients undergoing valve-sparing surgical procedures in the future.

4D flow cardiovascular magnetic resonance for monitoring of aortic valve repair in bicuspid aortic valve disease

“…In case of intraoperative findings like severe cusp calcifications or fenestrations, aortic valve repair was not performed and patients were not included in this study. The procedure of aortic valve repair has been previously described [2].…”

“…Bicuspid (BAV) and unicuspid (UAV) aortic valve malformations represent two forms of adult congenital heart disease with a prevalence of 1-2 and 0.02%, respectively [1][2][3][4]. BAV and UAV are associated with aortic valve dysfunction (regurgitation and/or stenosis), dissection, and proximal aortic dilatation, the so-called bicuspid aortopathy [5].…”

“…Surgical treatment for regurgitation and/or stenosis, particularly aortic valve repair techniques, underwent major development during the last decades. Surgical repair is a promising alternative to prosthetic aortic valve replacement, especially in young patients [2,[9][10][11]. Aortic valve repair has several advantages compared to aortic valve replacement, including absence of the need for chronic anticoagulation, lower infection rate, and better hemodynamic performance [12].…”

“…From a technical point of view, aortic valve repair is a two-component surgery, consisting of cusp repair and aortic valve annulus stabilization ( Fig. 1) [2]. However, recurrent aortic valve regurgitation is still a major issue in patients after aortic valve repair as compared to those after surgical aortic valve replacement [12][13][14].…”