Repair of Bicuspid Aortic Valves in Patients With Aortic Regurgitation

Abstract

Background-Bicuspid aortic valve regurgitation can be caused by a defect in the valve itself or by dysfunction of one or more components of the aortic root complex. A successful repair thus requires correction of all aspects of the problem simultaneously. We review our experience addressing both the valve and the aortic root when correcting bicuspid valve regurgitation. Methods and Results-Between 1996 and 2004, we treated 68 patients for aortic regurgitation. Thirty patients had isolated aortic regurgitation, and 38 had an associated ascending aortic aneurysm. All patients were treated using a standardized and integrated surgical technique, which included resection of the median raphe or leaflet plication, subcommissural annuloplasty, reinforcement of the leaflet free edge, and sinotubular junction plication. In the 38 patients with proximal aortic dilatation, reimplantation or remodeling of the aortic root was performed. Immediate postoperative echocardiography showed grade Յ1 aortic regurgitation in all patients. Three patients nonetheless needed an early re-operation because of recurrent regurgitation. No hospital mortality was observed. At a mean follow-up of 34 months after surgery, all patients were in New York Heart Association (NYHA) class 1 or 2. Two patients needed a re-operation (23 and 92 months, respectively). Echocardiographic follow-up showed no progression of the regurgitation in 58 surviving patients. Four patients progressed to grade 2 regurgitation. Conclusion-Our data indicate that regurgitant bicuspid aortic valves, whether alone or in association with a proximal aortic dilatation, can be repaired successfully provided that both the valve and the aortic root problems are treated simultaneously.

Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve–Sparing Surgery

“…16 However, satisfactory mid-term results have been reported with these techniques. [17][18][19] The similar outcomes for bicuspid and tricuspid AVs in sparing surgery reported by Shäfers and colleagues (Aicher et al 20 ) and confirmed in this series (Table 4) support the approach of bicuspid valve preservation, even when cusp repair is more frequent and complex than in the tricuspid AV.…”

Valve Configuration Determines Long-Term Results After Repair of the Bicuspid Aortic Valve

“…8,23,24 The application of valve-preserving aortic replacement has been published using both root remodeling and valve reimplantation. 6,20,25 In the meantime, it has become evident that reconstruction of the aortic valve is associated with fewer valve-related complications than reported previously for valve replacement. 16,26 The present results principally confirm the positive early results published previously in patients with BAVs.…”

Functional Anatomy of Aortic Regurgitation

“…The techniques used to spare or repair the aortic valve have been described elsewhere. 2,3,16 In addition to aortic surgery, 63 patients needed an additional procedure, including mitral valve repair in 29, tricuspid valve annuloplasty in 4, coronary artery bypass graft surgery in 24, closure of an atrial septal defect in 5, and closure of a ventricular septal defect in 1.…”

“…In recent years, however, repair techniques for diseased aortic valves have received increasing attention. [1][2][3][4][5][6][7][8][9][10] Innovations in operative techniques, an improved understanding of the functional anatomy of the aortic valve and root, as well as an increased awareness of the mechanisms leading to AR have undoubtedly contributed to this renewed interest. 11,12 Recently, we have described a functional classification of AR that addresses most of the pathological aspects of leaking aortic valves.…”