Repair of regurgitant bicuspid aortic valves: A systematic approach
(2010) The Journal of Thoracic and Cardiovascular Surgery — Vol. 140, n° 2, p. 276-284 (2010)
Files
pdfdocument.pdf
Restricted Access - Adobe PDF
- 515.49 KB
Details
- Authors
- Abstract
- 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. Raphe 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. (J Thorac Cardiovasc Surg 2010;140:276-84)
- Affiliations
Citations
Boodhwani, M., de Kerchove, L., Glineur, D., Rubay, J., Vanoverschelde, J.-L., El Khoury, G., & Noirhomme, P. (2010). Repair of regurgitant bicuspid aortic valves: A systematic approach. The Journal of Thoracic and Cardiovascular Surgery, 140(2), 276-284. https://doi.org/10.1016/j.jtcvs.2009.11.058 (Original work published 2010)