Bicuspid aortic valve repair: systematic review on long-term outcomes

Abstract

Background: Many patients with bicuspid aortic valve (BAV) develop aortic regurgitation but are not considered for valve repair. This is partly due to limited long term data regarding repair durability. The purpose of the review is to summarize the long-term (1 year) outcomes of BAV repair. Methods: A systematic review was performed to evaluate durability and survival following BAV repair. OVID SP versions of MEDLINE and Embase were searched using 'aortic valve', 'bicuspid', 'repair', 'David' 'Yacoub', 'reimplantation' and 'remodeling'. Results: Initial search produced 770 abstracts, reduced to 92 full papers for review after excluding duplications and abstract review for relevance. Twenty-six studies met full inclusion criteria. BAV repair revealed low operative mortality, with excellent 5-year survival, and low freedom from reoperation. Differences in surgical technique between reimplantation and remodeling do not appear to confer protection against reintervention. Systematic assessment of cusp height and annular stabilization in some form do appear to favor improved long term durability. Leaflet calcification is associated with higher rates of reintervention. Conclusions: BAV repair is associated with acceptable long term survival. Ongoing standardized outcome assessments will further refine surgical techniques associated with excellent repair durability.

4D flow cardiovascular magnetic resonance for monitoring of aortic valve repair in bicuspid aortic valve disease

“…1) [2]. However, recurrent aortic valve regurgitation is still a major issue in patients after aortic valve repair as compared to those after surgical aortic valve replacement [12][13][14]. Therefore, the development of more durable aortic valve repair techniques remains an important clinical challenge.…”

Commentary: Designing better broken hearts: Modeling regurgitant bicuspid aortic valve disease

“…Despite a number of staunch advocates, the broader use of aortic valve repair has been hampered by lack of standardization of repair techniques and scant data demonstrating reproducibility and long-term durability. 1 Potential advantages of repair include freedom from complications specific to replacement, including structural valve degeneration and patient-prosthesis mismatch for bioprostheses, bleeding complications for mechanical valves, and lower risk of endocarditis. Repair is also particularly appealing for the pediatric population, who may outgrow valve prostheses.…”

Aortic valve–sparing procedures in patients with aortic valve insufficiency: a single‑center experience

“…The procedure helps avoid the need for anticoagulation, decrease the risk of infections and endocarditis, and optimize aortic valve hemodynamics. 2 Aortic insufficiency (AI) often results from a progressive connective tissue disorder of the aorta leading to dilation of the aortic annulus, aortic root, and ascending aorta. The pathogenesis of aortopathy involves congenital or acquired degenerative mechanisms.…”

“…The undeniable advantages of aortic repair have recently been confirmed in long -term follow -up. 2 The latest state -of -the -art aortic repair (apart from aortic valve leaflet repairs) entails the complex stabilization of the aortic annulus and aortic root, which enhances the durability of the procedure. 2,6,12 Multicenter trials…”

“…Specific measurements are taken perioperatively, including effective height, coaptation length, and a ventriculoaortic junction diameter. 2,13 The most recent solid evidence indicates that reparative procedures should play an important role in aortic surgery. However, they should be conducted in cardiac surgery centers that collaborate with multidisciplinary teams with great expertise in surgery, diagnostics, and intensive care.…”