Two different geometric orientations for aortic neoroot creation in bicuspid aortic valve repair with root reimplantation.
Publication/Presentation Date
7-1-2020
Abstract
OBJECTIVE: Bicuspid aortic valve (BAV) represents 2 cusps oriented along a spectrum of equal (180°/180°) or unequal (150°/210°) leaflet surface area distribution along the aortic annular plane. We have taken the approach of respecting the native geometric orientation of the repaired BAV leaflets when creating the aortic neoroot during valve-sparing root reimplantation (VSRR) procedures. We investigated midterm outcomes with this 2-prong approach for VSRR in BAV syndrome.
METHODS: Of 72 patients in a prospectively maintained BAV repair database, 68 met inclusion criteria: 36 patients had 180°/180° neoroot geometry, and 32 patients had 150°/210° orientation. A multivariate ordinal logistic mixed effects model was performed to study parameters associated with recurrent AI greater than 2+.
RESULTS: Preoperative parameters were similar between 180°/180° and 150°/210° groups, except for greater incidence of AI 4+ in the latter (50.0% [n = 16] vs 8.3% [n = 3]; P < .001). Postoperatively, stroke, renal failure, reoperation for bleeding, and pacemaker rates were 0 in the entire cohort. In-hospital/30-day mortality in the entire cohort was 1.5% (n = 1). Multivariate ordinal logistic mixed effects model showed that preoperative AI greater than 3+ (odds ratio, 0.4; P = .46) and geometric orientation of the aortic neoroot (odds ratio, 3.8; P = .25) were not significantly associated with recurrence of AI greater than 2+.
CONCLUSIONS: Respecting BAV geometry for VSRR neoroot creation yields excellent midterm outcomes and may minimize conjoint cusp leaflet stress that may occur in "forcing" a 150°/210° type I BAV into a 180°/180° neoroot.
Volume
160
Issue
1
First Page
47
Last Page
57
ISSN
1097-685X
Published In/Presented At
Siki, M. A., Habertheuer, A., Bavaria, J. E., Komlo, C., Hunt, M., Freas, M. A., Milewski, R. K., Desai, N. D., Szeto, W. Y., & Vallabhajosyula, P. (2020). Two different geometric orientations for aortic neoroot creation in bicuspid aortic valve repair with root reimplantation. The Journal of thoracic and cardiovascular surgery, 160(1), 47–57. https://doi.org/10.1016/j.jtcvs.2019.06.119
Disciplines
Medicine and Health Sciences
PubMedID
31982122
Department(s)
Department of Surgery
Document Type
Article