6533b825fe1ef96bd1281f85

RESEARCH PRODUCT

Mid-term results of bicuspid aortic valve repair guided by morphology and function assessment.

Francesco GuccionePietro DioguardiGiacomo MuranaGiuseppe NassoSebastiano CastrovinciKhalil FattouchMarco MoscarelliPatrizio LancellottiGiuseppe Speziale

subject

Pulmonary and Respiratory MedicineAortic valveMalemedicine.medical_specialtyTime FactorsHeart VentriclesMid term resultsHeart Valve DiseasesAortic root dilatation030204 cardiovascular system & hematologyPreoperative careVentricular Function Left03 medical and health sciences0302 clinical medicineAortic valve repairBicuspid aortic valvePostoperative ComplicationsBicuspid Aortic Valve DiseaseRecurrenceInternal medicineMedicineHumansHospital MortalityRetrospective StudiesPericardial patchbusiness.industryIncidenceMiddle Agedmedicine.diseaseSurvival Ratemedicine.anatomical_structureTreatment Outcome030228 respiratory systemItalyEchocardiographyConcomitantAortic Valvecardiovascular systemCardiologySurgeryFemaleCardiology and Cardiovascular MedicinebusinessFollow-Up Studies

description

Bicuspid aortic valve (BAV) is frequently associated with aortic insufficiency (AI) due to cusp disease and/or aortic root dilatation. Based on functional classification and morphology, a systematic surgical approach was used for aortic valve repair (AVr).From 2004 to 2014, 152 consecutive patients (mean age 55 ± 7 years) with BAV underwent AVr with or without concomitant aortic root surgery. Cusp pathology was treated with central plication in 60 (39.5%) patients, free edge reinforcement in 45 (29.6%), triangular resection in 28 (18.4%) and pericardial patch in 19 (12.5%). Aortic root dilatation was corrected with valve sparing reimplantation in 65 patients. Mean follow-up was 68 ± 36 months.In-hospital death was 1.3%. Overall 5-year survival was 88.6 ± 3.6%. Freedom from recurrent ≥ grade 2 AI requiring reoperation at 5-year was 93 ± 3.1%. Five-year freedom from reintervention was 98.4 ± 1.6%, 93.3 ± 6.4% and 82.6 ± 9.6 in the group of patients treated with AVr and reimplantation technique, AVr and subcommissural plasty and AVr repair alone (log-rank P  = 0.005). Commissural orientation 160°, type 2 Siever's BAV and preoperative annulus diameter 29 mm were identified as predictors for recurrent ≥ grade 2 AI.BAV repair could be achieved with low incidence of recurrent AI, especially when concomitant annulus stabilization was performed. Systematic preoperative morphological and functional characteristics of the aortic valve should be carried out in order to reduce the risk of repair failure.

10.1093/icvts/ivx027https://pubmed.ncbi.nlm.nih.gov/28379458