Remodeling+Ring (modified Yacoub) technique for the treatment of bicuspid aortic valve regurgitation with ascending aortic aneurysm: A case report / 中国胸心血管外科临床杂志

@#Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.

Value of aortic root CTA assessment in aortic valve surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the data of preoperative aortic root CT angiography (CTA), compare it with two-dimensional transthoracic echocardiography and investigate the correlation of the two measurements with the actual intraoperative measurement data. Methods    Clinical data of 53 patients with aortic valve diseases who underwent aortic valve repair in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 38 males and 15 females with an average age of 42.9±18.3 years ranging from 10 to 77 years. Preoperative two-dimensional transthoracic echocardiography (TTE) and aortic root CTA measurements were collected, including aortic valve annulus (AVA), aortic sinus (Sinus) and sino-tubular junction (STJ). In comparison with the intraoperative measurements during the aortic valve repair surgery, the consistency analysis was performed. Results    Both the preoperative echocardiography AVA measurements and the CT AVA measurements were positively correlated with the intraoperative AVA measurements (P<0.001). Compared with the echocardiography AVA data [correlation coefficient (ρ)=0.74, mean squared error (MSE)=12.78], the CT AVA data were more accurate and consistent with the intraoperative AVA measurements (ρ=0.95, MSE=2.72). CT AVA data had a higher correlation coefficient with the intraoperative measurements, compared to that of  the echocardiography AVA data (P<0.001). Conclusion    In comparison with two-dimensional transthoracic echocardiography, preoperative morphological evaluation of aortic root CTA is more consistent with the actual intraoperative measurements during aortic valve repair surgery.

Mid-term clinical outcome analysis of aortic valve repair for rheumatic aortic valve disease / 中华胸心血管外科杂志

Objective:To evaluate the mid-term outcomes of patients with rheumatic heart disease who underwent aortic valve repair surgery in a prospective cohort.Methods:From January 2016 to December 2020, a total of 54 patients with rheumatic heart disease underwent aortic valve repair surgery in Beijing Anzhen Hospital, with an average age of (50.61±13.29) years, including 29 females (53.7%). There were 31 patients (57.4%) had pure aortic insufficiency, 2 patients (3.7%) had pure aortic stenosis and 21 patients (38.9%) had mixed lesion. During the same period, 43 patients (80.0%) underwent mitral valve surgery, 36 patients (66.7%) underwent tricuspid valve surgery, and 20 patients (37.0%) underwent atrial fibrillation radiofrequency ablation.The follow-up period was from 1 month to 61 months (median follow-up was 25 months). Paired rank-sum test was used to compare the differences in continuous variables among subjects, and Kaplan- Meier method was used to analyze the clinical outcomes during the follow-up period. Results:Proportion of moderate and severe aortic regurgitation Preoperatively was higher than that of discharge data, aortic valve orifice maximum velocity and left ventricular end-diastolic diameter were significantly lower than discharge data (all P<0.05). The 5-year survival rate was (96.1±2.7)% (2 patients died). The 5-year freedom from reoperation after aortic valve repair was (89.5±4.5)%(5 patients underwent redo surgery). The 5-year freedom from valvular-related complications was (91.3±4.2)%(3 patients suffered from complications). Conclusion:Aortic valve repair surgery for rheumatic aortic valve disease is feasible and has excellent early and mid-term results, it can be a reliable treatment option.

A Case of Successful Valve Repair in Traumatic Aortic Regurgitation Associated with the Dilated Aortic Annulus / 日本心臓血管外科学会雑誌

Here, we present a case of successful aortic valve repair of traumatic aortic regurgitation (AR). A man in his early twenties had a chest blunt trauma due to a bicycle accident 6 years earlier and suffered sternum fracture. He recovered without cardiovascular complications. Three months previously, a new diastolic murmur was detected on medical checkup. Transthoracic echocardiography (TTE) showed severe AR, and the left ventricular end-diastolic-/end-systolic dimension was 69/51 mm. Transesophageal echocardiography showed severe AR with perforation of the non-coronary cusp and dilatation of the aortic annulus (29.6 mm). Aortic valve repair was performed with an autologous pericardial patch and external suture annuloplasty. Postoperative TTE showed normal aortic valve function with trivial AR. He was discharged on postoperative day 11. Three months later, TTE showed trivial AR along with a reduced left ventricular dimension and improved left ventricular ejection fraction.

Bicuspidization of the Unicuspid Aortic Valve by Preserving the Free Margin Tissue / 日本心臓血管外科学会雑誌

A 35-year-old man was referred to our hospital for surgical repair of grade IV/IV aortic regurgitation secondary to a congenital unicuspid aortic valve accompanied by aneurysm of the ascending aorta. The aortic valve was the unicuspid unicommissural type and a fully developed commissure was located in the left lateral position (left coronary/right coronary). The anterior (non-coronary/right coronary) and posterior (non-coronary/left coronary) borders were rudimentary with calcified raphe. We performed aortic valve repair in combination with valve sparing root replacement (reimplantation) and partial arch replacement. We converted the unicuspid into a bicuspid aortic valve by preserving his own free margin tissue and creating a neocommissure to the 180 degrees opposite side of the left lateral commissure at the same height by enlarging the cusp with a glutaraldehyde-treated autologous pericardium patch to the cusp belly. The patient was discharged on the 17th postoperative day with trace aortic regurgitation. We successfully repaired the unicuspid aortic valve by augmenting the cusp size using a pericardium patch in order to preserve the free margin of the cusp.

Aortic Valve Repair for Infective Endocarditis of an Aortic Valve / 日本心臓血管外科学会雑誌

Infective endocarditis of the aortic valve tends to cause structural damage such as aortic root abscess, and aortic valve replacement is the standard treatment. However, there have been several reports on aortic valve repair for the treatment of infective endocarditis, and it has subsequently emerged as a feasible alternative to aortic valve replacement in selected patients. We report a case of aortic valve repair for infective endocarditis of the aortic valve caused by α-hemolytic Streptococcus. A 50-year-old man was admitted to our hospital with a two-month history of fever of unidentified origin. Transthoracic echocardiography revealed infective endocarditis of the aortic valve. Transesophageal echocardiography confirmed vegetation in the right coronary and non-coronary cusps, and mild aortic regurgitation. Although infection was controlled by approximately one month of antibiotic treatment, there was markedly more severe aortic regurgitation compared to the previous examination. These findings were confirmed on transesophageal echocardiography, and residual vegetation on the right coronary cusp as well as a perforation in the non-coronary cusp were confirmed. Intraoperative findings revealed a perforation in the non-coronary cusp and dehiscence, with vegetation on the right coronary cusp. The vegetation was carefully removed, the non-coronary cusp perforation was repaired with a pericardium patch, and the defect on the right coronary cusp was directly sutured with 6-0 polypropylene. Intraoperative transesophageal echocardiography revealed trivial aortic regurgitation. The postoperative course was uneventful and the patient was discharged 7 days after surgery without any complications. Antibiotics were prescribed for 3 months, and transthoracic echocardiography was performed 5 days, 1 month, and 3 months after surgery. No evidence of recurrence of aortic regurgitation or infection of the aortic valve was observed.

Advances of aortic valve repair for aortic regurgitation / 中国胸心血管外科临床杂志

@#The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.

Surgical treatment of incompetent quadricuspid aortic valve / 中华胸心血管外科杂志

Objective To summarize the surgical results of patients with quadricuspid aortic valve and aortic regurgitation.Methods From June 2013 to June 2017,4 patients with incompetent quandricuspid aortic valve underwent surgical repair at Guangzhou Women and Children's Medical Center.The age at surgery was 2 months to 5 years,and body weight was 2.7-22.7 kg.3 patients were diagnosed with persistent tmncal arteriosus and underwent complete repair.Another one was diagnosed with tetralogy of Fallot and accepted complete repair 4 years age.All patients were diagnosed with more than moderate quandricuspid aortic valve regurgitation.Repair was performed by tricuspidalization of the native quadricuspid valve,using leaflet and related sinus of Valsalva excision.Results There was no mortality.The ICU stay and hospital stay after operation were 7-12 days and 10-16 days.The follow-up duration was 3 to 51 months.All patients were alive and free from significant aortic valve regurgitation.Conclusion Aortic valve remodeling by leaflet excision and reduction annuloplasty is an effective method for incompetent quadricuspid aortic valve repair.

The aortic valve reconstruction with autologous pericardium by individual sizing technique / 中华胸心血管外科杂志

Objective To conclude the preliminary results of aortic valve repair with autopericardium.Methods After routine median sternotomy the pericardium was isolated and immersed into the 0.6% glutaraldehyde immersion for 10 minutes, then rinsed off before use.Conventional extracorporeal circulation was established and diseased aortic valves were removed.The curves lengths between three commissures measured with the specific sizers.The corresponding size of the pericardial patchs was used to cut the new aortic leaflets.The continuous Johnson Prolene 4-0 sutures were used to fixed the new aortic valve leaflets to the anulus.Another new 4-0 prolene suture were used to fix the new three commissures outside the aortic wall with mat.The new mat stripes were used to fix the sinus in condition with the aortic sinus dilation or bileaflets malformation.Results Since 2015 October total 27 patients received aortic valve repair with autologous pericardium.The age was in the range of 27 to 60 years old including 18 female and 9 male.There were 7 cases diagnosed as aortic valve stenosis and 20 cases aortic insufficiency.And there were 3 cases bileaflets aortic valve deformity.The mean bypass time is(104±25)mins.Postoperative esophageal ultrasound showed good coaptation of the aortic valve without significant regurgitation.The mean transvalve gradient was(8.5±3.2)mmHg(1 mmHg=0.133 kPa).In the early stage one case diagnosed with aortic valve stenosis and regurgitation received monocusp repaired with autologous pericardial leave.But there was still moderate aortic regurgitation and had to receive the aortic valve replacement.All patients recovered well and were treated with Aspirin for 6 months.The followed up lasted for 3 to 13 months.Mean aortic occlusion time was(104±25) minutes.The patients were followed up for 3-13 months, the cardiac function and aortic valve function were stable, and no gradient increased.Conclusion It is relatively simple to perform the aortic valve repair with individual autologous pericardial sizer technique and the primary clinic results are satisfactory.It is worthy of further study and long-term follow-up.

Clinical outcomes of aortic valve repair for aortic regurgitation / 中华胸心血管外科杂志

Objective To analyze early-and mid-term outcomes of aortic valve repair(AVr) for patients with aortic re gurgitation(AR).Methods From April 2010 to December2013,94 patients underwent elective aortic valve repair(AVr) for aortic regurgitation(AR).There were 36 male and 58 female,and the mean age was(51.3 ± 18.0) (6-75)years.There were 2 patients(2.1％) with severe AR,88 patients (93.6 ％) with moderate AR,and 4 patients (4.3％) with mild AR.The total number of the aortic valve lesions were 110,including 31 for annnlar dilatation,1 for leaflets fenestrations,1 for leaflets vcgctation,61 for leaflets prolapses,11 for leaflets calcification or thickness,and 4 for commissure fusion.We performed the annuloplasty for 32 patients including commissure plicature for 20 patiengs,subcommissural annuloplasty for 11 patients,valve-sparing aortic root replacement for 1 patient,and the valvuloplasty for 78 patients,including leaflets plicature for 2 patients,commissure suspension for 59 patients,leaflets shaving for 11 patients,commissure resection for 4 patients,leaflet patch repair for 1 patient,and leaflets vegetation msection for 1 patient.The concomitant procedures include coronary artery bypass grafting for 18 patients,mitral valve replacement/repair for 72,tricuspid valve replacement/repair for 75,congenital heart disease correction for 27,and ascending aorta plasty for 9.Results There was no case with aorta re-erossclamp,or aortic valve replacement due to AVr failure.In-hospital mortality was 4.25％ (4/94).Postoperative echocardiography showed 75 patients (79.8％)with none AR,13 (13.8％) with mild regurgitation,and 6 (6.4％) with moderate regurgitation.There was no severe AR post operative.AR gradient reduced in 94.7 ％ (89/94) of patients.The mean follow-up period was (30.6 ± 10.4) months,and the overall survival and the freedom of re operation for aortic valve were 100％.Conclusion There was good early-and mid-term outcomes of aortic valve repair for patients with aortic regurgitation.

Clinical outcomes of aortic valve repair for aortic regurgitation / 中华胸心血管外科杂志

Objective To analyze early-and mid-term outcomes of aortic valve repair(AVr) for patients with aortic re gurgitation(AR).Methods From April 2010 to December2013,94 patients underwent elective aortic valve repair(AVr) for aortic regurgitation(AR).There were 36 male and 58 female,and the mean age was(51.3 ± 18.0) (6-75)years.There were 2 patients(2.1％) with severe AR,88 patients (93.6 ％) with moderate AR,and 4 patients (4.3％) with mild AR.The total number of the aortic valve lesions were 110,including 31 for annnlar dilatation,1 for leaflets fenestrations,1 for leaflets vcgctation,61 for leaflets prolapses,11 for leaflets calcification or thickness,and 4 for commissure fusion.We performed the annuloplasty for 32 patients including commissure plicature for 20 patiengs,subcommissural annuloplasty for 11 patients,valve-sparing aortic root replacement for 1 patient,and the valvuloplasty for 78 patients,including leaflets plicature for 2 patients,commissure suspension for 59 patients,leaflets shaving for 11 patients,commissure resection for 4 patients,leaflet patch repair for 1 patient,and leaflets vegetation msection for 1 patient.The concomitant procedures include coronary artery bypass grafting for 18 patients,mitral valve replacement/repair for 72,tricuspid valve replacement/repair for 75,congenital heart disease correction for 27,and ascending aorta plasty for 9.Results There was no case with aorta re-erossclamp,or aortic valve replacement due to AVr failure.In-hospital mortality was 4.25％ (4/94).Postoperative echocardiography showed 75 patients (79.8％)with none AR,13 (13.8％) with mild regurgitation,and 6 (6.4％) with moderate regurgitation.There was no severe AR post operative.AR gradient reduced in 94.7 ％ (89/94) of patients.The mean follow-up period was (30.6 ± 10.4) months,and the overall survival and the freedom of re operation for aortic valve were 100％.Conclusion There was good early-and mid-term outcomes of aortic valve repair for patients with aortic regurgitation.

Aortic Valve Repair of Traumatic Aortic Regurgitation to a Young Woman / 日本心臓血管外科学会雑誌

<p>A 28-year-old woman with no underlying health issues was injured in a motorcycle accident and taken to our hospital by ambulance when she was 26 years old. Though she was diagnosed with multiple trauma, upon arrival at the hospital neither cardiac murmurs nor cardiac abnormalities on transthoracic echocardiography were detected. She was managed conservatively, and discharged on hospital day 16. She experienced dyspnea upon mild effort, and an early diastolic murmur appeared. She was again referred to our hospital, and diagnosed with severe aortic regurgitation. We scheduled an aortic valve replacement using an bioprosthetic valve because she intended to give birth. We also considered simultaneous aortic root enlargement as her aortic annulus was small. We performed the surgery 2 years after the initial motorcycle accident. Perioperatively, we noticed that her non-coronary cusp was torn. We converted the procedure to an aortic valve repair using an autologous pericardial patch. Her aortic regurgitation disappeared after the operation, and she was discharged on postoperative day 14. We successfully preserved the aortic valve cusps and avoided the need for anticoagulant therapy.</p>

Aortic Valve Repair of Aortic Valve Insufficiency in the Young Woman after Congenital Heart Disease Operation / 日本心臓血管外科学会雑誌

Interest in aortic valve repair has been growing for more than a decade. Since ross and associates 1) first introduced single cusp enlargement, cusp extension or replacement of aortic valve insufficiency has been used with rheumatic and congenital aortic valve disease. There is more interest on the effectiveness and durability of the leaflet extension technique with autologous pericardium and long-term clinical results. A 29-year-old woman had suffered from aortic valve insufficiency after congenital heart disease operation. Echocardiography and computed tomography showed right cusp shortening with severe aortic valve regurgitation. We perfomed right cusp extension with bovine pericardium and central plication. According to some reports, the stability of autologous pericardium being better than bovine pericardium, but this case could not use a autologous pericardium because of a previous operation. The patient had an uneventful postoperative course and pregnancy became possible.

Surgical Management of Aortic Root Dilatation with Advanced Aortic Regurgitation: Bentall Operation versus Valve-sparing Procedure

BACKGROUND: Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. MATERIALS AND METHODS: A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. RESULTS: The mean follow-up duration was 4.9+/-3.1 years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of 4.4+/-2.5 years of echocardiographic follow-up (p<0.001). CONCLUSION: Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures.

Anesthetic management for combined mitral valve replacement and aortic valve repair in a patient with osteogenesis imperfecta.

Osteogenesis imperfecta is a rare disorder of connective tissues and presents multiple challenges, including difficult airway, hyperthermia, coagulopathy and respiratory dysfunction, for anesthesiologists, especially during cardiac surgery. We present anesthetic management of a patient with osteogenesis impertecta during double valve surgery. Dexmedetomidine infusion minimized the risks of malignant hyperthermia. Glidescope and in-line stabilization facilitated endotracheal intubation and protected his oral structures and cervical spine. Transesophageal echocardiography (TEE) diagnosed a flail A3 segment and redundant left coronary cusp causing mitral and aortic regurgitation. The mitral valve was replaced and the aortic valve repaired. Coagulopathy was corrected according to comprehensive coagulation analysis. Glidescope, dexmedetomidine, coagulation analysis and TEE could facilitate anesthetic management in these patients.

Modified Aortic Root Remodeling Combined with Aortic Valve Repair Technique for Severe Aortic Regurgitation Resulting from Prolapse of the Right Coronary Cusp and Aortic Root Dilatation / 日本心臓血管外科学会雑誌

A 70-year-old man who had been followed up in our outpatient clinic for mild aortic regurgitation underwent curative surgery for progression of the regurgitation due to a prolapsed right coronary cusp, associated with annular dilatation and aortic root aneurysm formation. The Operation consisted of subvalvular circular annuloplasty to reduce the size of the aortic annulus, adjustable leaflet suspension for the prolapsed right coronary cusp, and modified aortic root remodeling, which replaced the Valsalva sinus of both non and right coronary cusps while sparing the Valsalva sinus of the left coronary cusp. Coronary artery bypass grafting was additionally performed for the 90% stenosis of the proximal right coronary artery segment. The postoperative course was uneventful with no need of blood transfusion. He was discharged from the hospital 10 days postoperatively. This combination of valvuloplasty with valve-sparing aortic root reconstruction procedure can be useful.

Aortic Valve Repair / 한양의대학술지

Repair of the aortic valve has received considerably less attention than repair of the mitral or tricuspid valves. Reasons for this may include the greater incidence of stenosis in the aortic valve relative to insufficiency, the degenerative processes that lead to valvular dysfunction reducing the number of potentially repairable valves, and the presence of a wider variety of valve substitutes with lower thromboembolic potential and greater longevity than for the mitral position. Furthermore, the functional structure and redundancy of the mitral and tricuspid valves may be more amenable to plastic techniques. Most surgeons treat all aortic valve pathology with a replacement. In part, this management strategy is justified by the excellent long-term results with available prostheses. Since valve replacement in the younger adult has the inherent problems associated with anticoagulation and/or prosthesis durability, repair, if durable, has the potential for a good solution in this patient population. We reviewed the surgical indications, techniques, clinical results, and current status of aortic valve repair.

Aortic Valve Repair / 한양의대학술지

Repair of the aortic valve has received considerably less attention than repair of the mitral or tricuspid valves. Reasons for this may include the greater incidence of stenosis in the aortic valve relative to insufficiency, the degenerative processes that lead to valvular dysfunction reducing the number of potentially repairable valves, and the presence of a wider variety of valve substitutes with lower thromboembolic potential and greater longevity than for the mitral position. Furthermore, the functional structure and redundancy of the mitral and tricuspid valves may be more amenable to plastic techniques. Most surgeons treat all aortic valve pathology with a replacement. In part, this management strategy is justified by the excellent long-term results with available prostheses. Since valve replacement in the younger adult has the inherent problems associated with anticoagulation and/or prosthesis durability, repair, if durable, has the potential for a good solution in this patient population. We reviewed the surgical indications, techniques, clinical results, and current status of aortic valve repair.

Early Results of Aortic Valve-sparing Procedures in Patients with Annuloaortic Ectasia / 대한흉부외과학회지

BACKGROUND: Aortic valve-sparing procedures could reduce valve-related morbidity, but may increase operative risks; therefore, these procedures could not be performed routinely. We attempted to find out the early results while focusing on the operative risks associated with these procedures in our hospital. MATERIAL AND METHOD: From May 1996 to July 2003, 26 patients underwent these procedures including 15 patients with Marfan syndrome and 1 patient with Behcet disease. There were 17 men and 9 women with mean age of 37.9+/-19.2 years (range: 6 months~74 years). Ten patients had ascending aortic dissection, 18 patients had more than moderate degree of aortic valve insufficiency (AI). Two types of valve-sparing procedures were performed: valve reimplantation in 14 and root remodeling in 12 patients. Associated procedures were performed as follows: aortic valve plasty in 6, mitral valve plasty in 5, hemi-arch replacement in 4, total arch replacement in 2, coronary artery bypass surgery in 1 and Maze procedure in 1 patient(s). RESULT: In four patients, valve-sparing procedures were converted to Bentall procedures during operation. Including these patients, there was no operative deaths, 3 patients underwent re-operation due to bleeding, 1 patient had permanent pacemaker. The median duration of ICU stay was 45.5 hours, the median duration of hospital stay was 10.5 days. In 22 patients excluding 4 converted patients, intra- operative transesophageal echocardiogram (TEE) showed less than mild degree of AI in all except one who had not received intra-operative TEE in the beginning and showed moderate degree of AI at discharge. The mean duration of follow-up was 21.2+/-27.4 months. All patients were alive except one who died during other departmental surgery. In 3 patients, more than moderate degree of AI was recurred, but there were no re- operation. CONCLUSION: Aortic valve-sparing procedures could be performed relatively safely in selected patients who had annuloaortic ectasia.

Mid-term Results of the Congenital Bicuspid Aortic Valve Repair / 대한흉부외과학회지

BACKGROUND: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. MATERIAL AND METHOD: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). RESULT: Mean age was 41+/-14 years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of 38+/-17 months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from 1.9+/-0.6 to 1.2+/-0.5 (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from 45+/-9 and 67+/-10 to 37+/-10 and 56+/-10, respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative (3.1+/-1.2) to post-bypass (0.9+/-0.7). However, the grade at last follow-up (1.7+/-1.1) was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. CONCLUSION: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.