Bicuspid aortic valve repair: outcomes after 17 years of experience

Abstract

OBJECTIVES This study presents the results of 17 years of experience with bicuspid aortic valve (BAV) repair and the analysis of factors associated with repair failure and early echocardiographic outcome. METHODS Between 2003 and 2020, a total of 206 patients [mean age: 44.5 ± 15.2 years; 152 males (74%)] with BAV insufficiency with or without aortic dilatation underwent elective aortic valve repair performed by a single surgeon with a mean follow-up of 5 ± 3.5 years. The transthoracic echocardiography examinations were reported. RESULTS There were no deaths during the hospital stay, and all but 1 patient survived the follow-up period (99.5%). Overall, 10 patients (5%) developed severe insufficiency and 2 (1%) developed aortic dilatation requiring reoperation. Freedom from reoperation at 7 years reached 91.8%. Type 2 BAV configuration [hazard ratio (HR) 3.9; 95% confidence interval (CI): 1.01–60; P = 0.049], no sinotubular junction remodelling (HR 7; 95% CI: 1.7–23; P = 0.005), no circumferential annuloplasty (HR 3.9; 95% CI: 1.01–64; P = 0.047) and leaflet resection (HR 5.7; 95% CI 1.2–13. P = 0.017) have been identified as a risk factor of redo operation. Parameters of the postoperative left ventricle reverse remodelling improved significantly early after the operation and later at 2 years evaluation. CONCLUSIONS The repair of BAV offers good short- and mid-term results providing a significant reverse left ventricular remodelling. Type 0 BAV preoperative configuration, circumferential annuloplasty and sinotubular junction remodelling are associated with better repair durability.

Early outcomes of valve preservation in patients with ascending aortic aneurysm and bicuspid valve disease

“…Marek and colleagues, (7) in a study was to evaluate outcomes after 17 years of experience in repair of bicuspid aortic valve reported that 3% of patients were diabetic, 30% of patients were hypertensive, 5 % patients were smokers which confors with our preoperative parameters. The preoperative echo parameters (EF, ES and ED) were recorded for all our patients and revealed that mean EF 61.68±6.73%, ES 4.09±0.39cm and mean ED was 6.1±0.45cm.…”

“…The preoperative echo parameters (EF, ES and ED) were recorded for all our patients and revealed that mean EF 61.68±6.73%, ES 4.09±0.39cm and mean ED was 6.1±0.45cm. Similarly Jasinki and collegues, (5) in their study which was to evaluate a 17 year outcome after bicuspid aortic valve repair they revealed that preoperative mean EF 58.0±7.83%, ES 4.0±1.4cm and mean ED was 6.0±1.5cm. The cross clamp was also measured for all patients, the mean cross clamp time was 123.02±10.11minutes and bypass time was measured for all patients, the mean bypass time was 150.28±11.57minutes.…”

“…BAV is more frequent in males than in females. Also Jasinki and collegues, (5) conducted a study to evaluate a 17 year outcome after bicuspid aortic valve repair showed 73% males and mean age 42 years. In another study by Alsoufi and colleagues, (6) was to evaluate the results of valve preservation and repair for bicuspid aortic valve insufficiency they revealed that the mean age of 71 patients is 41.5±13.2 years.…”

Long‐term durability of valve‐sparing or repair procedures in BAV—Is there room for improvement?

“…Similarly, the Mayo group presented that the gradient can increase over time and may be responsible for late calcifications and stenosis. 3 Indeed, this failure pattern was noticed by authors in 25% of redo-operations in their paper. In very recent clinical data, it has been observed that proper annuloplasty is helpful in achieving better coaptation, especially for the asymmetric type BAV 1 or 2 or type 0 according to Sievers.…”

Solid aortic annuloplasty opening up for new valve sparing options

“…The concept of durable annuloplasty ring could have an analogous effect in the case of a bicuspid aortic valve (BAV). Recently, the importance of circumferential annuloplasty in achieving durability of BAV repair has been proven, 6 and the BAV‐dedicated internal ring annuloplasty technology has been finally validated and applied clinically 7 . Inspired by the authors' excellent results in TAV, internal ring annuloplasty in BAV patients with additional replacement of nonfused sinus seems to be very promising.…”