Article Abstract

Bicuspid aortic valve repair in the setting of severe aortic insufficiency

Authors: Ziv Beckerman, Michael O. Kayatta, LaRonica McPherson, Jose N. Binongo, Yi Lasanajak, Bradley G. Leshnower, Edward P. Chen


Background: Bicuspid aortic valve (BAV) is a common cardiac anomaly that affects 0.5–2% of adults. Valve sparing root replacement (VSRR) in bicuspid aortopathy is gaining popularity. We discuss the technical aspects of the procedure as well as the mid- to long-term results of performing VSRR in the setting of a bicuspid valve.
Methods: A single institutional database identified 280 patients who underwent VSRR from 2005–2016. Outcomes were analyzed in 60 consecutive patients undergoing a VSRR in the setting of a BAV with aortic regurgitation (AR). Patients were followed prospectively and had annual echocardiograms.
Results: The average age in this series was 42±11 years. Moderate or more AR was present in 50% of patients preoperatively. The incidence of operative death, stroke, and renal failure was 0%. Mean follow-up was 39±30 months. At latest follow-up, 62% of patients had zero AR and 87% of patients had <1+ AR. At 9 years, freedom from >2+ AR was 97% and freedom from aortic valve repair (AVR) was 96%.
Conclusions: VSRR can be safely and effectively performed in young patients with bicuspid valve anatomy regardless of degree of pre-operative AR. Valve function is durable and the incidence of valve-related complications is low. VSRR is an attractive and potentially superior option to conventional root replacement in appropriately selected patients with bicuspid aortopathy.