BACKGROUND: The aim of this study was to evaluate the longer-term results of bicuspid aortic valve (BAV) repair with or without aortic root replacement. METHODS: From 1999 to 2017, 142 patients with or without aortic root dilatation who underwent repair of a regurgitant BAV were included in the study. Ninety-four patients underwent isolated BAV repair (Group 1; median age 43 years) and 48 patients underwent valve-sparing aortic root replacement plus BAV repair (aortic valve reimplantation-Group 2; median age 48 years). Median clinical follow-up time was 5.9 years (range 0.5-15) in Group 1 and 3 years (range 0.5-16) in Group 2, respectively. RESULTS: In-hospital mortality was 1% in Group 1, and 2% in Group 2 (p = .6). The 5- and 10-year survival was 93 ± 2.9% and 81 ± 5.8% in Group 1 and 96 ± 3.1% and 96 ± 3.1% in Group 2, respectively (p = .31). Eleven patients of Group 1 (1.7%/patient-year) and five patients of Group 2 (2.2%/patient-year) underwent reoperation of the aortic valve (p = .5). The 5- and 10-year freedom from reoperation were 93.0 ± 2.1% and 77.1 ± 7.1% in Group 1 and 93.0 ± 5.0% and 76.7 ± 9.6% in Group 2 (p = .83), respectively. At the latest follow-up, only two patients of Group 1 and 1 patient of Group 2 had AV regurgitation = 2° (p = .7). The cumulative linearized incidence of all valve-related complications (bleeding, stroke, endocarditis, and reoperation) was 2.9%/patient-year in Group 1% and 4%/patient-year in Group 2, respectively (p = .6). CONCLUSIONS: Isolated BAV repair and combined aortic valve reimplantation plus BAV repair provide good clinical longer-term outcomes with relatively low reoperation rate and durable valve function.

Department of Cardiac Surgery Faculty of Medicine in Hradec Kralove University Hospital Hradec Kralove and Charles University Hradec Kralove Czech Republic

Department of Cardiac Surgery University Hospital Bonn Bonn Germany

Department of Cardiovascular Surgery University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt Frankfurt Germany

J Card Surg. 2022 May;37(5):1456. doi: 10.1111/jocs.16341. PubMed

J Card Surg. 2022 Aug;37(8):2492. doi: 10.1111/jocs.16522. PubMed

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Bravemann AC, Guven H, Beardslee MA, Makan M, Kates AM, Moon MR. The bicuspid aortic valve. Curr Probl Cardiol. 2005;30:470-522.

Della Corte A, Bancone C, Quarto C, et al. Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression. Eur J Cardiothorac Surg. 2007;31:397-404.

Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55:2789-2800.

Fedak PW, Verma S, David TE, Leask RL, Weisel RD, Butany J. Clinical and pathophysiological implications of a bicuspid aortic valve. Circulation. 2002;106:99-4.

Doss M, Moidl R, Wood JP, Miskovic A, Martens S, Moritz A. Pericardial patch augmentation for reconstruction of incompetent bicuspid aortic valves. Ann Thorac Surg. 2005;80:304-307.

Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Progn Cardiovasc Dis. 2020;63:457-464.

Ouzounian M, Feindel CM, Manlhiot C, David C, David TE. Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves. J Thorac Cardiovasc Surg. 2019;158:1-9.

Holubec T, Zacek P, Jamaliramin M, et al. Valve cuspidity: a risk factor for aortic valve repair? J Card Surg. 2014;29:585-592.

Mangini A, Contino M, Romagnoni C, et al. Aortic valve repair: a ten-year single-centre experience. Interact Cardiovasc Thorac Surg. 2014;19:28-35.

David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617-621.

Moritz A, Risteski P, Dogan S, et al. Six stitches to create a neosinus in David-type aortic rot resuspension. J Thorac Cardiovasc Surg. 2007;133:560-562.

Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg. 2007;133:1226-1233.

Baumgartner H, Falk V, Bax JJ, et al. ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-2791.

Casselman FP, Gillinov AM, Akhrass R, Kasirajan V, Blackstone EH, Cosgrove DM. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg. 1999;15:302-308.

Svensson LG, Al Kindi AH, Vivacqua A, et al. Long-term durability of bicuspid aortic valve repair. Ann Thorac Surg. 2014;97:1539-1547.

Aicher D, Kunihara T, Abou Issa O, Brittner B, Graber S, Schäfers HJ. Valve configuration determines long-term after repair of the bicuspid aortic valve. Circulation. 2011;123:178-185.

Karliova I, Schneider U, Ehrlich T, Schäfers HJ. Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg. 2020;109:728-735.

Mosala Nezhad Z, de Kerchove L, Hechadi J, et al. Aortic valve repair with patch in non-rheumatic disease: indication, techniques and durability. Eur J Cardiothorac Surg. 2014;46:997-1005.

Al Halees Z, Al Shahid M, Al Sanei A, Sallehuddin A, Duran C. Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothorac Surg. 2005;28:200-205.

Jamieson WR, Burr LH, Miyagishima RT, et al. Carpentier-Edwards supra-annular aortic porcine bioprosthesis: clinical performance over 20 years. J Thorac Cardiovasc Surg. 2005;130:994-1000.

Thudt M, Papadopoulos N, Monsefi N, et al. Long-term results following pericardial patch augmentation for incompetent bicuspid aortic valves: a single center experience. Ann Thorac Surg. 2017; 103:1186-1192.

Salem R, Zierer A, Karimian-Tabrizi A, et al. Aortic valve repair for aortic insufficiency or dilatation: Technical evolution and long-term outcomes. Ann Thorac Surg. 2020;110:1967-1974.