Long-Term Durability of Bicuspid Aortic Valve Repair

Svensson, Lars; Kindi, Adil H. Al; Vivacqua, Alessandro; Pettersson, Gösta; Gillinov, A. Marc; Mihaljević, Tomislav; Roselli, Eric E.; Sabik, Joseph F.; Griffin, Brian P.; Hammer, Donald; Rodriguez, L. Leonardo; Williams, Sarah; Blackstone, Eugene H.; Lytle, Bruce W.

doi:10.1016/j.athoracsur.2013.11.036

Cited by 99 publications

(97 citation statements)

References 32 publications

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“…In all cases, a commisuroplasty was performed with subcommisural and/or supracommisural sutures. 11 Aortic valve replacement. Most patients in this series underwent aortic valve replacement (n ¼ 23; 73%), and the most common indication was aortic regurgitation (n ¼ 15).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Outcomes after repair or replacement of dysfunctional quadricuspid aortic valve

Idrees

Roselli

Arafat

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: Surgical Techniquesmentioning

confidence: 99%

Outcomes after repair or replacement of dysfunctional quadricuspid aortic valve

Idrees

Roselli

Arafat

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…5 Furthermore, bicuspid valve repair—40% combined with aortic surgery—carried a 0.47% risk of hospital death and a 0.25% risk of stroke, and long-term durability improved over time with newer techniques, such as higher commissure implantation. 8 However, how reparative procedures compare with mechanical and biologic graft root replacement alternatives in the long term remains unclear. 6,9 …”

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confidence: 99%

Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement

Svensson

Pillai

Rajeswaran

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Objective To evaluate long-term results of aortic root procedures combined with ascending aorta replacement for aneurysms, using 4 surgical strategies. Methods From January 1995 to January 2011, 957 patients underwent 1 of 4 aortic root procedures: valve preservation (remodeling or modified reimplantation, n = 261); composite biologic graft (n = 297); composite mechanical graft (n = 156); or allograft root (n = 243). Results Seven deaths occurred (0.73%), none after valve-preserving procedures, and 13 strokes (1.4%). Composite grafts exhibited higher gradients than allografts or valve preservation, but the latter 2 exhibited more aortic regurgitation (2.7% biologic and 0% mechanical composite grafts vs 24% valve-preserving and 19%allografts at 10 years). Within 2 to 5 years, valve preservation exhibited the least left ventricular hypertrophy, allograft replacement the greatest; however, valve preservation had the highest early risk of reoperation, allograft replacement the lowest. Patients receiving allografts had the highest risk of late reoperation (P<05), and those receiving composite mechanical grafts and valve preservation had the lowest. Composite bioprosthesis patients had the highest risk of late death (57%at 15 years vs 14%-26%for the remaining procedures, P<.0001), because they were substantially older and had more comorbidities (P<.0001). Conclusions These 4 aortic root procedures, combined with ascending aorta replacement, provide excellent survival and good durability. Valve-preserving and allograft procedures have the lowest gradients and best ventricular remodeling, but they have more late regurgitation, and likely, less risk of valve-related complications, such as bleeding, hemorrhage, and endocarditis. Despite the early risk of reoperation, we recommend valve-preserving procedures for young patients when possible. Composite bioprostheses are preferable for the elderly.

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“…Indeed, as demonstrated by the results of the current study and others pertaining to complex aortic root and ascending aortic surgeries, the most appropriate option would be to offer this only at high-volume experienced centers that have demonstrated excellent surgical outcomes, after shared decision making. 10,[36][37][38][39][40][41] These findings need prospective validation, especially in patients with an isolated BAV aortopathy.…”

Section: Discussionmentioning

confidence: 99%

Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With Bicuspid Aortic Valve and a Dilated Ascending Aorta

Masri

Kalahasti

Svensson

et al. 2017

Circ: Cardiovascular Imaging

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Background— In patients with bicuspid aortic valve and dilated proximal ascending aorta, we sought to assess (1) factors associated with increased longer-term cardiovascular mortality and (2) incremental prognostic use of indexing aortic root to patient height. Methods and Results— We studied 969 consecutive bicuspid aortic valve patients (50±13 years; 87% men) with proximal aorta ≥4 cm, who also had a gated contrast-enhanced thoracic computed tomography or magnetic resonance angiography. A ratio of ascending aortic area/height was calculated on tomography, and ≥10 cm 2 /m was considered abnormal, as previously reported. Society of Thoracic Surgeons score and cardiovascular death were recorded. Greater than or equal to III+ aortic regurgitation and severe aortic stenosis were seen in 37% and 10%, respectively. Society of Thoracic Surgeons score and right ventricular systolic pressure were 2±3 and 15±16 mm Hg, respectively. Abnormal ascending aortic area/height ratio was noted in 33%; 44% underwent ascending aortic surgery at 34 days. At 10.8 years (interquartile range, 9.6–12.3), 82 (9%) died (0.4% in-hospital postoperative mortality). On multivariable Cox survival analysis, ascending aortic area/height ratio (hazard ratio, 2; 95% confidence interval, 1.20–3.35) was associated with cardiovascular death, whereas aortic surgery (hazard ratio, 0.46; confidence interval, 0.26–0.80) was associated with improved survival (both P <0.01). Of the 405 patients with ascending aortic diameter of 4.5 to 5.5 cm, 64% had an abnormal ascending aortic area/height ratio, and 70% deaths occurred in patients with an abnormal ratio. Conclusions— In bicuspid aortic valve patients with dilated proximal ascending aorta, ascending aortic area/height ratio was independently associated with cardiovascular death.

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Long-Term Durability of Bicuspid Aortic Valve Repair

Cited by 99 publications

References 32 publications

Outcomes after repair or replacement of dysfunctional quadricuspid aortic valve

Outcomes after repair or replacement of dysfunctional quadricuspid aortic valve

Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement

Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With Bicuspid Aortic Valve and a Dilated Ascending Aorta

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