Comparison of bicuspid and tricuspid aortic valve repair

Abstract

OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44–56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96–37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99–9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

Comparative Analysis of Long-Term Outcomes in Valve-Sparing Aortic Root Reimplantation: Full Sternotomy versus Mini-Sternotomy Approach

“…A gradual approach involving the incorporation of progressively complex surgical steps, such as supracoronary replacements with or without AVR, simple aortic valve repairs, Bentall procedures, and finally, David procedures, may further enhance the surgical team's expertise in performing mini-VSARR effectively. On the other hand, there are inherent between-patient differences in the two reporting centers; firstly, the number of BAVs was significantly lower in the mini-VSARR than in the sternotomy-VSARR group; this may reflect the small sample size and early experience in BAV repairs in the mini-sternotomy reporting center; on the other hand, while full sternotomy BAV repairs already have long-term durability results [30,31], mini-access to root and BAV repairs are only limited to case studies and, therefore, highly anticipated. Secondly, BAV cases were also younger, which translated into age difference between the two cohorts.…”

Neurological Impact of Slower Rewarming during Bypass Surgery in Infants

“…This technique is still being developed and improved by additional methods like SCP. 2 There is unfortunately no consistent intraoperative temperature management guideline for cardiac surgeons correcting CHDs.…”

“…Nowadays, selective cerebral perfusion (SCP) is the most widespread technique for neuroprotection. 2 3 Intraoperative hypoxia and other critical events trigger impaired outcomes. 4 Cerebral hypoperfusion is known to carry the highest risk during cooling and the subsequent rewarming phase during cardiopulmonary bypass (CPB).…”

Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis

“…Dr. Schafers first described the concept of effective height in 2007 and the application of aortic annuloplasty in 2009; following these reports, valve durability after the remodeling procedure was significantly improved [ 32 , 33 ]. Especially in patients with BAV, annuloplasty is a substantial element of repair due to the inherent annulus enlargement (annular ectasia) [ 34 ]. As mentioned above, cusp plasty was performed considerably more often in the BAV group, which indicated a higher rate of morphological alteration of BAV cusps at the time of operation.…”