Ulrich Schneider1, Susanne K Feldner1, Christopher Hofmann1, Jakob Schöpe2, Stefan Wagenpfeil2, Christian Giebels1, Hans-Joachim Schäfers3. 1. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany. 2. Institute for Medical Biometry, Epidemiology & Medical Informatics, Saarland University, Homburg/Saar, Germany. 3. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany. Electronic address: h-j.schaefers@uks.eu.
Abstract
OBJECTIVE: Bicuspid aortic valve anatomy is associated with ascending aortic aneurysm in approximately 50% of individuals and may lead to severe aortic regurgitation with aortic dilatation. Both entities may be treated by valve repair and root remodeling. The objective was to review the cumulative experience of 20 years. METHODS: Between November 1995 and December 2015, 357 patients (324 male; age 10-80 years; mean, 49 ± 13 years) underwent combined bicuspid aortic valve repair and root remodeling. Aortic regurgitation was relevant in 265 cases; the main indications for surgery were aortic regurgitation (n = 241), aortic aneurysm (n = 102), and acute dissection (n = 9). In 225 instances, a suture annuloplasty was added. Cusp calcification was present beyond the raphe in 52 cases, and an autologous pericardial patch was implanted for partial cusp replacement in 39 cases. All patients were followed. Follow-up was 97.8% complete with a mean of 57 ± 51 months (median, 39 months). RESULTS: Two patients died (hospital mortality 0.6%), and survival at 15 years was 81%. Reoperation became necessary for recurrent aortic regurgitation in 24 patients; 6 patients underwent reoperation for stenosis. Cumulative incidence of reoperation at 15 years was 21.7%. Cusp calcification and the use of a pericardial patch for cusp reconstruction were associated with time to reoperation (P = .002). CONCLUSIONS: Repair of the bicuspid aortic valve combined with root remodeling leads to excellent 10- and 15-year results. Cusp calcification and the need for partial cusp replacement are associated with valve failure.
OBJECTIVE: Bicuspid aortic valve anatomy is associated with ascending aortic aneurysm in approximately 50% of individuals and may lead to severe aortic regurgitation with aortic dilatation. Both entities may be treated by valve repair and root remodeling. The objective was to review the cumulative experience of 20 years. METHODS: Between November 1995 and December 2015, 357 patients (324 male; age 10-80 years; mean, 49 ± 13 years) underwent combined bicuspid aortic valve repair and root remodeling. Aortic regurgitation was relevant in 265 cases; the main indications for surgery were aortic regurgitation (n = 241), aortic aneurysm (n = 102), and acute dissection (n = 9). In 225 instances, a suture annuloplasty was added. Cusp calcification was present beyond the raphe in 52 cases, and an autologous pericardial patch was implanted for partial cusp replacement in 39 cases. All patients were followed. Follow-up was 97.8% complete with a mean of 57 ± 51 months (median, 39 months). RESULTS: Two patients died (hospital mortality 0.6%), and survival at 15 years was 81%. Reoperation became necessary for recurrent aortic regurgitation in 24 patients; 6 patients underwent reoperation for stenosis. Cumulative incidence of reoperation at 15 years was 21.7%. Cusp calcification and the use of a pericardial patch for cusp reconstruction were associated with time to reoperation (P = .002). CONCLUSIONS: Repair of the bicuspid aortic valve combined with root remodeling leads to excellent 10- and 15-year results. Cusp calcification and the need for partial cusp replacement are associated with valve failure.
Authors: Hector I Michelena; Alessandro Della Corte; Arturo Evangelista; Joseph J Maleszewski; William D Edwards; Mary J Roman; Richard B Devereux; Borja Fernández; Federico M Asch; Alex J Barker; Lilia M Sierra-Galan; Laurent De Kerchove; Susan M Fernandes; Paul W M Fedak; Evaldas Girdauskas; Victoria Delgado; Suhny Abbara; Emmanuel Lansac; Siddharth K Prakash; Malenka M Bissell; Bogdan A Popescu; Michael D Hope; Marta Sitges; Vinod H Thourani; Phillippe Pibarot; Krishnaswamy Chandrasekaran; Patrizio Lancellotti; Michael A Borger; John K Forrest; John Webb; Dianna M Milewicz; Raj Makkaar; Martin B Leon; Stephen P Sanders; Michael Markl; Victor A Ferrari; William C Roberts; Jae-Kwan Song; Philipp Blanke; Charles S White; Samuel Siu; Lars G Svensson; Alan C Braverman; Joseph Bavaria; Thoralf M Sundt; Gebrine El Khoury; Ruggero De Paulis; Maurice Enriquez-Sarano; Jeroen J Bax; Catherine M Otto; Hans-Joachim Schäfers Journal: Radiol Cardiothorac Imaging Date: 2021-07-22