ABSTRACT BODY:
Objective(s): In Bicuspid Aortic Valve Syndrome (BAVS) requiring valvular and supracoronary aortic replacement, the decision to retain the sinus segment or perform a full root is controversial. Therefore, parameters for safe retention of the sinus of valsalva are needed. This study tests the hypothesis that AVR and supracoronary aortic replacement permits retention and stabilization of the sinus segment in BAVS patients stratified by aortic valve dysfunction and STJ effacement.

Methods: From 2001-2011, a total of 1050 procedures were performed on BAV patients. AVR and supracoronary ascending aortic procedure was performed on 123 BAVS patients. Patients with emergent operation, dissection, or connective tissue disease were excluded. Pre-operative and most recent post-operative echocardiograms were analyzed on all patients. Patients were stratified by valve pathology, Aortic Stenosis (AS) (74.7%, n=92) or Severe Aortic Insufficiency (AI) (25.3%, n=26) and degree of STJ effacement defined as the STJ to annular ratio (Table). Mixed AS and AI were stratified as AS if aortic valve area was <1.45cm2.

Results: Mean follow-up was 2.25 years. Average age was 61+/-11.6 years (AS) and 47.6 +/-11.4 years (AI). There were zero 30 day mortalities. Zero patients required reoperation for aortic valve, ascending aorta, or aortic root replacement. There was one post-operative embolic stoke in an AS patient. Analysis of the AS patient cohort revealed a significant post-operative decrease in the sinus segment size in patients with Mild effacement compared to Normal STJ (p= 0.09) and Moderate effacement compared to Normal STJ (p=0.013) (Table). Analysis of AI patients revealed a significant decrease in post-operative sinus segment size between Normal and Mild STJ effacement (p=0.014) (Table). Patients with AI and moderate effacement showed a trend toward enlargement, however, statistical power was not reached. The 1, 5, and 10 year survival was 96%, 90%, and 87%.

Conclusions: The sinus of valsalva was stable in the postoperative follow-up period with a significant decrease in segment size as effacement increased from normal to moderate (AS) and normal to mild (AI). However, there was a trend to increased segment size in severe AI with moderate effacement. In BAVS patients with aortic valve and proximal aortic replacement, surgical decisions utilizing degree of aortic valve dysfunction and STJ effacement can predict postoperative sinus of valsalva stability and whether aortic root replacement is necessary.