Concepts of Bicuspid Aortic Valve Repair: A Review

Abstract

Background. The bicuspid aortic valve (BAV) frequently requires surgical intervention for aortic regurgitation (AR) and aneurysm. Valve-preserving surgery for BAV has evolved over the last 25 years.Methods. This review summarized experience in BAV repair with a special focus on predictors of failure and specific surgical techniques addressing them.Results. Excellent repair stability can be achieved if a standardized approach addressing all pathologic components of aortic valve and root is used. Anatomic variations must be addressed with special approaches.Conclusions. Today, BAV repair leads to excellent stability if an anatomy-oriented concept is used. Further improvements of cinical results and reproducibility can be anticipated.

Anomalous left circumflex artery: Implications for valve-sparing root replacement

“…Had annular stabilization been indicated, we would have performed a suture annuloplasty using an expanded polytetrafluorethylene suture, tied around a Hegar dilator. 7,8 We believe this technique would have allowed an annuloplasty with minimal risk of injury to the anomalous LCX. We would add this type of annuloplasty for annular dimensions exceeding 26-27 mm.…”

Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study

“…Sievers 1 BAV was modeled with one normal leaflet and a larger leaflet formed by fusion between that two remaining leaflets. Based on previous echocardiographic reports, the non-coronary leaflet and its sinus were modeled to span a circumferential angle of 120 o [ 10 ]. The two remaining leaflets were assumed to be identical and a raphe was placed along the free edge of these two leaflets.…”

Aortic valve sparing surgery—patient selection and techniques

“…Important considerations in this subset of patients are commissural height and orientation, cusp geometric height, aortic annulus dilatation and the presence of cusp prolapse (22,23). Careful valve assessment and patient selection is crucial in order to achieve mid-to longterm durability of the operation (24). When a raphe is present, raphe mobilization allows improved cusp mobility by increasing the geometric height of the fused cusp.…”

“…It is therefore difficult to state firm data on long-term outcomes. Nevertheless, the principles of bicuspid aortic valve repair are now clearly understood and standardized (24), and there is little doubt about the feasibility and mid-term durability of the operation (26)(27)(28). Indeed, in high volume centers with appropriate surgical expertise, results in bicuspid patients are comparable to those of patients with tricuspid valves (26)(27)(28)(29).…”