Aortic Annulus Diameter Affects Durability of the Repaired Bicuspid Aortic Valve.

BACKGROUND AND AIM OF THE STUDY: An investigation was made as to whether the preoperative aortic annular diameter affects the durability of bicuspid aortic valve (BAV) repair in patients who had undergone concomitant root stabilization with subcommissural annuloplasty (SCA) compared to valve-sparing root reimplantation (VSRR). METHODS: Among a retrospective review of 74 patients who underwent BAV repair between 2005 and 2012,42 had SCA and 32 had VSRR. RESULTS: The preoperative annulus was similar in the two groups (29 +/- 3 mm for SCA; 30 +/- 4 mm for VSRR, p = 0.3). Postoperative aortic insufficiency (AI) grade > or = 1+ was 100%, but five-year freedom from Al grade >1+ was lower in the SCA group (62 +/- 10% versus 92 +/- 6%, p = 0.02). On univariate analysis, a preoperative annulus 28 mm was predictive of recurrent Al grade >1+ in the SCA group (odds ratio 17.1, p = 0.05), but not in the VSRR group (3.31, p = 0.1). Consequently, SCA patients were evaluated by annular diameter 28 mm (n = 26) versus < or = 27 mm (n = 16). Five-year freedom from AI grade >1+ was lower for the 28 mm SCA subgroup (52 +/- 10% versus +/-3 +/- 6%, p = 0.02). Given this difference between the SCA subgroups, Al grade >1+ in the 28 mm SCA subgroup was compared to VSRR patients with annulus 28 mm ( 28 mm VSRR subgroup, n = 23). The five-year freedom from AI grade >1+ was significantly higher in the 28 mm VSRR subgrou+/- (86 +/- 10% versus 52 +/- 10%, p = 0.02), but simila < or = Sr in the 27 27 m< or = SCA and 527 mm VSRR subgroups (93 +/- 6% versus 100%, p = 0.4). CONCLUSION: For BAV patients with a preoperative aortic annulus 28 mm, SCA results in inferior midterm outcomes. VSRR or alternative annular stabilization techniques should be considered

Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: comparison with the 3-cusp David procedure.

OBJECTIVE: Valve-sparing root reimplantation (VSRR) in tricuspid aortic valve (TAV) patients is well established, but in bicuspid aortic valve (BAV) patients, it has been less widely adopted. We assessed whether valve type affects midterm outcomes with VSRR. METHODS: A retrospective review was performed of 186 patients who underwent an aortic valve-sparing root reimplantation operation between 2004 and 2013. Of these, 129 patients underwent elective VSRR with the David V technique. Outcomes were compared in this cohort by valve type: TAV (n = 89) versus BAV (n = 40). RESULTS: Demographics were similar in the 2 groups. BAV patients had a higher degree of aortic insufficiency (AI) at presentation (P < .05), and an enlarged preoperative annulus (30 ± 4 vs 28 ± 6 mm, P = .06). All BAV patients required primary leaflet repair (6% in the TAV group; P < .01). Postoperative mortality (0), stroke (0% vs 1%), and pacemaker requirement (0% vs 5%) were similar. Postoperative freedom from AI grade ≥2+ was 100% in the entire cohort, and transvalvular gradients were similar. At follow-up, a 1-year echocardiogram showed higher peak and mean transvalvular gradients in the BAV group (P < .01). One TAV group patient died from an unknown cause. The 5-year actuarial freedom from aortic valve reoperation was 100% versus 97% ± 3% (P = .6). Three patients in the entire cohort have had AI grade >2+ on follow-up (n = 1 in the BAV group; n = 2 in the TAV group). CONCLUSIONS: Even though BAV patients present with higher AI grade and require concomitant primary valve repair, the VSRR David V technique offers excellent midterm outcomes with both the BAV and TAV valve types.