Predictors of long-term stenosis in bicuspid aortic valve repair

Spadaccio, Cristiano; Nenna, Antonio; Henkens, Arnaud; Mastrobuoni, Stefano; Jahanyar, Jama; Aphram, Gaby; Lemaire, Guillaume; Vancraeynest, David; Khoury, Gébrine El; Kerchove, Laurent de

doi:10.1016/j.jtcvs.2022.04.024

Cited by 7 publications

(3 citation statements)

References 24 publications

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“…The most common reason for late reoperation was recurrent severe AR, in 3% of the entire study cohort (most occurred in TAV) followed by severe aortic stenosis at 2% (most occurred in BAV). Risk factors for aortic stenosis have been previously described in detail by our group (21).…”

Section: Discussionmentioning

confidence: 99%

Three decades of reimplantation of the aortic valve—the Brussels Experience

Jahanyar¹,

Kerchove²,

Arabkhani³

et al. 2023

Ann Cardiothorac Surg

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Background Over the last three decades, the importance of native valve preservation has increasingly become evident. Valve-sparing root replacement procedures, such as the reimplantation or remodeling technique, are therefore being progressively used for aortic root replacement and/or aortic valve repair. Herein, we are summarizing our single-center experience with the reimplantation technique. Methods We queried our prospective database for aortic valve repair and recruited all adult (≥18 years) patients who have undergone valve-sparing root replacement with the reimplantation technique between March 1998 and January 2022. We subcategorized the patients into three distinct groups: root aneurysm without aortic regurgitation (AR) (grade ≤1+), root aneurysm with AR (grade >1+) and isolated chronic AR (root <45 mm). Univariable logistic regression analysis was performed to identify variables of interest, which were further analyzed by multivariable Cox-regression analysis. Survival, freedom from valve reintervention, and freedom from recurrent regurgitation, were analyzed with the Kaplan-Meier method. Results A total of 652 patients were recruited for this study; 213 patients underwent reimplantation for aortic aneurysm without AR, 289 patients for aortic aneurysm with AR, and 150 patients with isolated AR. Cumulative survival was 95.4% (95% CI: 92.9–97.0%) after 5 years, 84.8% (80.0–88.5%) after 10 years, and 79.5% (73.3–84.5%) after 12 years, which was comparable to the age-matched Belgian population. Older age (HR 1.06, P≤0.001) and male gender (HR 2.1, P=0.02) were associated with late mortality. Freedom from reoperation on the aortic valve at 5 years was 96.2% (95% CI: 93.8–97.7%), and 90.4% (95% CI: 87.4–94.2%) at 12 years. Age (P=0.001) and preoperative left ventricular end-diastolic dimension (LVEDD) (P=0.03) were associated with late reoperation. Conclusions Our long-term data supports our reimplantation approach as a viable option for aortic root aneurysms and/or aortic regurgitation, with long-term survival that mirrors that of the general population.

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Section: Discussionmentioning

confidence: 99%

Three decades of reimplantation of the aortic valve—the Brussels Experience

Jahanyar¹,

Kerchove²,

Arabkhani³

et al. 2023

Ann Cardiothorac Surg

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“…However, data suggests that repair with patches or other techniques provides good outcomes (5). Leaflet thickening or retraction can be addressed by thinning, which will increase leaflet mobility and protect from long-term stenosis, particularly in BAV (6). In BAV, a gH of 20 mm is a good parameter to predict repair success.…”

Section: Valve-relatedmentioning

confidence: 99%

Patient selection for aortic valve-sparing operations

Jahanyar¹,

Kerchove²,

Tsai³

et al. 2023

Ann Cardiothorac Surg

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“…With the selective annuloplasty, the larger fused cusp sinus is reduced to an equal size to the originally smaller not fused sinus. Not only does the more mobile non-fused cusp now cover a relatively larger valve orifice area, but decreasing the fused cusp sinus, allows for direct closure of the line of fusion, preserving fused cusp mobility and obviating the need for pericardial patch extension, which has been associated with valve stenosis later ( 44 ). Long-term results with this technique are excellent and have previously been reported to restore normal life expectancy with a 97% 12-year survival and 91% 12-year freedom from AR > grade 2 ( 14 ).…”

Section: Bicuspid Aortic Valve Geometrymentioning

confidence: 99%

Functional and pathomorphological anatomy of the aortic valve and root for aortic valve sparing surgery in tricuspid and bicuspid aortic valves

Jahanyar¹,

Tsai²,

Arabkhani³

et al. 2023

Ann Cardiothorac Surg

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The aortic valve (AV) is a three-dimensional structure, with leaflets that are suspended within the functional aortic annulus (FAA). These structures (AV and FAA) are therefore intrinsically connected and disease of just one component can independently lead to AV dysfunction. Hence, AV dysfunction can occur in the setting of entirely normal valve leaflets. However, as these structures are functionally inter-connected, disease of one component can lead to abnormalities of the other over time. Thus, AV dysfunction is often multifactorial. Valve-sparing root procedures require an in-depth understanding of these inter-relationships, and herein we are providing a detailed account of some of the most pertinent anatomical relationships.

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Predictors of long-term stenosis in bicuspid aortic valve repair

Cited by 7 publications

References 24 publications

Three decades of reimplantation of the aortic valve—the Brussels Experience

Three decades of reimplantation of the aortic valve—the Brussels Experience

Patient selection for aortic valve-sparing operations

Functional and pathomorphological anatomy of the aortic valve and root for aortic valve sparing surgery in tricuspid and bicuspid aortic valves

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