Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: comparison with the 3-cusp David procedure.
Publication/Presentation Date
2-1-2015
Abstract
OBJECTIVE: Valve-sparing root reimplantation (VSRR) in tricuspid aortic valve (TAV) patients is well established, but in bicuspid aortic valve (BAV) patients, it has been less widely adopted. We assessed whether valve type affects midterm outcomes with VSRR.
METHODS: A retrospective review was performed of 186 patients who underwent an aortic valve-sparing root reimplantation operation between 2004 and 2013. Of these, 129 patients underwent elective VSRR with the David V technique. Outcomes were compared in this cohort by valve type: TAV (n = 89) versus BAV (n = 40).
RESULTS: Demographics were similar in the 2 groups. BAV patients had a higher degree of aortic insufficiency (AI) at presentation (P < .05), and an enlarged preoperative annulus (30 ± 4 vs 28 ± 6 mm, P = .06). All BAV patients required primary leaflet repair (6% in the TAV group; P < .01). Postoperative mortality (0), stroke (0% vs 1%), and pacemaker requirement (0% vs 5%) were similar. Postoperative freedom from AI grade ≥2+ was 100% in the entire cohort, and transvalvular gradients were similar. At follow-up, a 1-year echocardiogram showed higher peak and mean transvalvular gradients in the BAV group (P < .01). One TAV group patient died from an unknown cause. The 5-year actuarial freedom from aortic valve reoperation was 100% versus 97% ± 3% (P = .6). Three patients in the entire cohort have had AI grade >2+ on follow-up (n = 1 in the BAV group; n = 2 in the TAV group).
CONCLUSIONS: Even though BAV patients present with higher AI grade and require concomitant primary valve repair, the VSRR David V technique offers excellent midterm outcomes with both the BAV and TAV valve types.
Volume
149
Issue
2 Suppl
First Page
22
Last Page
28
ISSN
1097-685X
Published In/Presented At
Bavaria, J. E., Desai, N., Szeto, W. Y., Komlo, C., Rhode, T., Wallen, T., & Vallabhajosyula, P. (2015). Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve: comparison with the 3-cusp David procedure. The Journal of thoracic and cardiovascular surgery, 149(2 Suppl), S22–S28. https://doi.org/10.1016/j.jtcvs.2014.10.103
Disciplines
Medicine and Health Sciences
PubMedID
25500099
Department(s)
Department of Surgery
Document Type
Article