Bicuspid aortic valve sparing root replacement

Abstract

Background and Aim of Study: Mid and long-term data regarding the durability of bicuspid aortic valve sparing root replacement is not completely understood. In this study, our institutional experience is reviewed regarding this procedure with special attention to the operative technique. Methods: From 2004 to 2019, 1241 patients underwent aortic root replacement and of these 79 patients underwent bicuspid aortic valve sparing root replacement. Early and late outcomes along with echocardiographic data were reviewed. Univariate analysis was used to identify risk factors for mortality. Results: Median age at operation was 43 (inner quartile range: 34.5-50.5) years, with 17% (14) being female. Median follow up time was 4 (inner quartile range: 1-8) years with 359 years of total follow up. Early mortality was 2.5% (2). Overall 10-year freedom from aortic valve intervention was 95.6%. Risk factor analysis did not demonstrate preoperative root diameter, aortic diameter, or aortic insufficiency to be risk factors for mortality. Conclusion: Bicuspid aortic valve sparing root replacement can be performed safely in the setting of aortic root pathology and valve insufficiency. With appropriate selection and excellent surgical technique, long-term durable valve function is observed without the need for repeat valve intervention.

Fifteen‐year experience with the Tirone David procedure in bicuspid aortic valve: A safe option

“…We did, however, find a relatively frequent occurrence of type 0 (29.4%) compared to rates that Sievers et al reported (7%) 21 . Regarding intra‐ and postoperative outcomes, our data are in line with reports from other groups and confirm that AVSRR, such as the Tirone procedure, can be performed in patients with BAV with very low perioperative risks for morbidity and mortality (0%–2.5%) 8,11–13,16 . Most of our patients had elective surgery for the Tirone procedure without other associated surgery to exclude confounding from other procedures.…”

“…21 Regarding intra-and postoperative outcomes, our data are in line with reports from other groups and confirm that AVSRR, such as the Tirone procedure, can be performed in patients with BAV with very low perioperative risks for morbidity and mortality (0%-2.5%). 8,[11][12][13]16 Most of our patients had elective surgery for the Tirone procedure without other associated surgery to exclude confounding from other procedures. Holmgren et al however, still reported that even combined surgery was not associated with higher observed or relative mortality.…”

“…An alternative for such patients is aortic valve‐sparing root replacement (AVSRR), which has been used with good results for three decades in patients with tricuspid aortic valves 6,7 but remains debated as an intervention for patients with BAV 8,9 . The aim of this study was to assess short and midterm clinical and safety outcomes with AVSRR, specifically Tirone's procedure, in patients with BAV 10–14 …”

Transcatheter Aortic Valve Replacement for Bicuspid Aortic Insufficiency After Valve-Sparing Aortic Root Replacement

“…Over the past years, a modified surgical technique offers BAV patients with root aneurysms to replace the dilated segment while preserving the valvular components ( 3 ). The VSARR was associated with lower surgical complications such as heart block and cerebral hemorrhage and had a higher survival rate than the traditional Bentall surgical procedure, which also uses replacement of the aortic valve ( 4 ).…”

Anatomy of the retrograde type A aortic dissection after endovascular repair of type B aortic dissection: a case report

“…The supracoronary aortic prosthesis with the "full root" technique is a complete cross-section of the aortic diameter, removal of the dissected area of the ascending aorta and placement of the prosthesis of the ascending aorta above the coronary arteries (approximately 1.5-2 cm), as high as possible to the place of discharge of the brachiocephalic artery with inserting circular (3600) anastomoses, without preserving the posterior wall of the ascending aorta, using the principles of the "free tension technique" (18). The supracoronary prosthesis of the ascending aorta is performed when there are no additional dissections of the intima in the projection of the aortic root (the sinuses of Valsalva, coronary arteries ostia), with no hemodynamically significant pathologies of the aortic valve, in patients without annulo-aortic ectasia (19) and without additional ruptures of the aortic intima in the zone of the aortic arch.…”