Longer-term Outcomes after Bicuspid Aortic Valve Repair in 142 Patients

Abstract

Background The aim of this study was to evaluate the longer-term results of bicuspid aortic valve (BAV) repair with or without aortic root replacement. Methods From 1999 to 2017, 142 patients with or without aortic root dilatation who underwent repair of a regurgitant BAV were included in the study. Ninety-four patients underwent isolated BAV repair (Group 1; mean age 45±14 years) and 48 patients underwent valve-sparing aortic root replacement plus BAV repair (aortic valve reimplantation – Group 2; mean age 49±13 years. Median follow-up time was 5.9 years (range 0.5-15) in Group 1 and 3 years (range 0.5-16) in Group 2, respectively. Results In-hospital mortality was 1% in group 1, and 2% in Group 2 (p=0.6). The 5- and 10-year survival was 93±2.9% and 81±5.8% in Group 1 and 96±3.1% and 96±3.1% in Group 2, respectively (p=0.31). Eleven patients of Group 1 (1.7% /patient-year) and 5 patients of Group 2 (2.2%/patient-year) underwent reoperation of the aortic valve (p=0.5). The 5- and 10-year freedom from reoperation were 93.0±2.1% and 77.1±7.1% in Group 1 and 93.0±5.0% and 76.7±9.6% in Group 2 (p=0.83), respectively. At latest follow-up only 2 patients of Group 1 and 1 patient of Group 2 had AR=2° (p=0.7). The cumulative linearized incidence of all valve-related complications (bleeding, stroke, endocarditis, reoperation) was 2.9%/patient-year in Group 1 and 4%/patient-year in Group 2, respectively (p=0.6). Conclusions Isolated BAV repair and combined aortic valve reimplantation plus BAV repair provide good clinical longer-term outcomes with relatively low reoperation rate and durable valve function.

Reply to Jasinski M et al.: “Indeed, there is still room for improvement in long‐term durability of BAV repair”

“…The concept behind the augmentation was to achieve larger effective orifice area, which is given by the nature smaller in BAV than in tricuspid AV 4 and consequently achieve lower postoperative transvalvular gradients. As already mentioned in our original article 2 the pericardial patch augmentation in our cohort seems to have a negative impact on BAV repair durability as 92% of patients in Group 1, who had to be reoperated on the AV or had recurrent AR ≥ 2°in the follow-up, receive this technique. Similar trend was observed in Group 2 (67%).…”

“…on our manuscript entitled "Longer-term outcomes after bicuspid aortic valve (BAV) repair in 142 patients." 2 We agree with their statements and we will touch all their points and answer their questions in this Reply.…”

Reply to Jasinski M et al.: ´Indeed, there is still room for improvement in long‐term durability of BAV repair´

“…1 We thank Dr Jasinski et al for their valuable comments and question on our manuscript entitled 'Longer-term outcomes after bicuspid aortic valve repair in 142 patients'. 2 We agree with their statements and we will touch all their points and answer their questions in this Reply.…”

Bicuspid aortic valve repair: An ongoing struggle in material science

“…Safari et al 1 present the results of bicuspid aortic valve (BAV) repair in 142 patients. The authors conclude that isolated BAV repair and combined aortic valve reimplantation plus BAV repair provide good clinical longer‐term outcomes with relatively low reoperation rate and durable valve function.…”