AATS: American Association for Thoracic Surgery.
Watch the AATS Leadership Video
 
Valve Repair for Regurgitant Bicuspid Aortic Valves: A Systematic Approach
Munir Boodhwani, Laurent de Kerchove, David Glineur, Robert Verhelst, Jean Rubay, Christine Watremez, Pasquet Agnes, Philippe Noirhomme, Gebrine El Khoury; Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint Luc, Brussels, Belgium
READER COMMENTS
Objective: Young patients with bicuspid aortic valves (AV) can present with aortic insufficiency (AI) due to disease of the leaflet or of the aortic root and functional aortic annulus. Valve repair is emerging as an attractive and feasible alternative to valve replacement for bicuspid aortic valve insufficiency. We present a single center experience with a functional approach to bicuspid aortic valve repair focusing on valve assessment and systematic application of repair techniques (Figure 1).
Methods: Between 1995 and 2008, 121 consecutive patients (mean age: 44 ± 12 years) with bicuspid aortic valves underwent non-emergent valve repair for isolated AI (43%), aortic root dilatation (13%), or both (44%). Preoperative echocardiography identified aortic dilatation (n = 75), cusp prolapse (n = 96), and cusp restriction (n = 45) as contributory mechanisms of AI which were confirmed on surgical inspection. Conjoint cusp raphe repair was performed in 97 patients by shaving (22%) or resection of the raphe with primary closure (60%) or pericardial patch augmentation (18%). Cusp prolapse (n = 80) was repaired by free margin plication and/or free margin reinforcement with PTFE suture. All patients underwent a functional aortic annuloplasty using sub-commissural annuloplasty (n = 52), ascending aortic replacement (n = 17) or aortic root replacement (n = 54) using a reimplantation (76%) or remodelling technique (24%). Clinical (median: 57 months, range [1 - 147]) and echocardiographic (median: 40 months, range [1 - 143]) follow-up was complete in 99% of patients. Kaplan-Meier and Cox regression analyses were used.
Results: There was no operative mortality. Five patients underwent early aortic valve reoperation (3 re-repairs, 2 Ross procedure). Post-repair, intraoperative echocardiography revealed AI grade 0/1 in all patients. On discharge echocardiography, 92% of patients had AI grade 0/1 and 8% had grade 2 AI. Three additional patients underwent aortic valve replacement during follow-up. Overall survival was 97 ± 3% at 8 years. At 5 and 8 years follow-up, freedom from AV reoperation was 95 ± 4% and 92 ± 7% and freedom from AV replacement was 97 ± 3% and 94 ± 6%. Freedom from recurrent AI (> 2+) was 94 ± 5% and from valve related events was 88 ± 4% at 5 years.
Conclusion: A systematic approach to bicuspid aortic valve repair yields good early and mid-term results. Repair of bicuspid valves for AI is a feasible and attractive alternative to mechanical valve replacement in young patients.

Back to 2009 Annual Meeting
Back to Program Outline
Back to Main Program
Policies | Find a Surgeon | About | Contact
We Model Excellence
 Follow AATS on Facebook
Copyright © American Association for Thoracic Surgery. All rights reserved.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.