Valve Configuration Determines Long-Term Results After Repair of the Bicuspid Aortic Valve

Abstract

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

Repair of the Regurgitant Bicuspid or Tricuspid Aortic Valve

“…The favorable impact of an eccentric AR jet is more difficult to explain because an eccentric jet is more likely in valves with a small range of free commissural aperture orientation and has been linked to higher rates of structural valve deterioration and reoperation. 23 Finally, the number and location of raphes and the extent of their fusion 23 may affect the late success of reconstructive operations for BAV. BAVs with larger angles and complete cusp fusion have been linked to favorable functional outcomes.…”

Aortic Valve Reconstruction With Autologous Glutaraldehyde-Treated Pericardium

“…They proposed that the effective height should be >8-9 mm after aortic valve repair for long-term maintenance of a competent aortic valve. 9, 10 The effective height after aortic valve reconstruction in the procedure by Ozaki et al 2 was greater than 10 mm; therefore, the long-term durability of the aortic valve with a commercially available bioprosthesis. First, aortic cusps are prepared using glutaraldehyde-treated autologous pericardium.…”

Bicuspid Aortic Valve Disease: New Insights

“…34 However, patients with a repairable BAV and a dilated aortic annulus (≥28 mm diameter) often do not do well with a simple subcommissural annuloplasty. 35 In a large surgical series of 316 BAV patients who underwent aortic root remodeling surgery, Aicher and colleagues demonstrated that a larger aortic annular diameter, BAV leaflet configuration, younger age, a lower effective height (i.e. measure of coaptation line to the annulus), and need for cusp repair using a pericardial patch, were all independent risk factors for reoperation.…”

“…measure of coaptation line to the annulus), and need for cusp repair using a pericardial patch, were all independent risk factors for reoperation. 35 This was likely because a subcommissural annuloplasty may be inadequate at stabilizing the aortic annulus and halt the progressive BAV-associated aortopathy. Therefore, stabilization of the aortic annulus with AVS root reimplantation may constitute a more appropriate surgery in this subset of patients.…”