Repair of regurgitant bicuspid aortic valves: A systematic approach

• Published in: Journal of thoracic and cardiovascular surgery (Print) Vol. 140; no. 2; pp. 276 - 284.e1
• Main Authors: Boodhwani, Munir, MD, MMSc, de Kerchove, Laurent, MD, Glineur, David, MD, Rubay, Jean, MD, Vanoverschelde, Jean-Louis, MD, Noirhomme, Philippe, MD, El Khoury, Gebrine, MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01-08-2010; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Valve - abnormalities; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - surgery; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Echocardiography, Transesophageal; Endocardial and cardiac valvular diseases; Female; Heart; Heart Valve Prosthesis Implantation; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Pneumology; Recurrence; Reoperation; Replantation; Retrospective Studies; Time Factors; Treatment Outcome; aortic valve; 35.1; AV; bicuspid aortic valve; BAV; AI; aortic insufficiency; Corrective surgery; Treatment; Cardiac valvular disease; Bicuspid aortic valve; Cardiovascular disease; Anesthesia; Surgical approach; Circulatory system; Cardiology; Repair; Congenital disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2009.11.058

Objective Patients with bicuspid aortic valves can present with aortic insufficiency caused by cusp disease or the aortic root pathology. We present our 13-year experience with a functional and systematic approach to bicuspid aortic valve repair. Methods Between 1995 and 2008, 122 consecutive patients (mean age, 44 ± 11 years) with bicuspid aortic valves underwent non-emergency valve repair for isolated aortic insufficiency (43%), aortic root dilatation (14%), or both (43%). Preoperative echocardiography identified aortic dilatation (n = 75), cusp prolapse (n = 96), and cusp restriction (n = 45) as mechanisms of aortic insufficiency. Raphé repair (n = 98) was performed by shaving (21%) or resection with primary closure (60%) or pericardial patch (18%). Functional aortic annuloplasty was performed using subcommissural annuloplasty (n = 51), ascending aortic replacement (n = 17), or aortic root replacement (n = 54) using a reimplantation (76%) or remodeling technique (24%). Results There was no operative mortality. Five patients underwent early aortic valve reoperation (3 re-repairs). At discharge, 93% of patients had aortic insufficiency grade 0/1 and 7% of patients had grade 2. Seven additional patients underwent aortic valve reoperation during follow-up (2 re-repairs). Overall survival was 97% ± 3% at 8 years. At 5 and 8 years follow-up, freedom from aortic valve reoperation was 94% ± 2% and 83% ± 5%, respectively, and freedom from aortic valve replacement was 96% ± 2% and 90% ± 5%, respectively. Freedom from recurrent aortic insufficiency (>2+) was 94% ± 3% at 5 years. Freedom from thromboembolism and bleeding was 96% ± 2% at 8 years. Conclusion A systematic approach to bicuspid aortic valve repair yields good early and midterm results. Repair of bicuspid valves for aortic insufficiency is a feasible and attractive alternative to mechanical valve replacement in young patients.