Repair of regurgitant bicuspid aortic valves: a systematic approach

Patients with bicuspid aortic valves can present with aortic insufficiency caused by cusp disease or the aortic root pathology. We present our 13-year experience with a functional and systematic approach to bicuspid aortic valve repair. Between 1995 and 2008, 122 consecutive patients (mean age, 44 +...

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Vydáno v:	The Journal of thoracic and cardiovascular surgery Ročník 140; číslo 2; s. 276
Hlavní autoři:	Boodhwani, Munir, de Kerchove, Laurent, Glineur, David, Rubay, Jean, Vanoverschelde, Jean-Louis, Noirhomme, Philippe, El Khoury, Gebrine
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.08.2010
Témata:	Adult Aortic Valve - abnormalities Aortic Valve - diagnostic imaging Aortic Valve - surgery Aortic Valve Insufficiency - diagnostic imaging Aortic Valve Insufficiency - etiology Aortic Valve Insufficiency - mortality Aortic Valve Insufficiency - surgery Cardiac Surgical Procedures - adverse effects Cardiac Surgical Procedures - mortality Echocardiography, Transesophageal Female Heart Valve Prosthesis Implantation Humans Kaplan-Meier Estimate Male Middle Aged Recurrence Reoperation Replantation Retrospective Studies Time Factors Treatment Outcome
ISSN:	1097-685X, 1097-685X
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Shrnutí:	Patients with bicuspid aortic valves can present with aortic insufficiency caused by cusp disease or the aortic root pathology. We present our 13-year experience with a functional and systematic approach to bicuspid aortic valve repair. Between 1995 and 2008, 122 consecutive patients (mean age, 44 +/- 11 years) with bicuspid aortic valves underwent non-emergency valve repair for isolated aortic insufficiency (43%), aortic root dilatation (14%), or both (43%). Preoperative echocardiography identified aortic dilatation (n = 75), cusp prolapse (n = 96), and cusp restriction (n = 45) as mechanisms of aortic insufficiency. Raphé repair (n = 98) was performed by shaving (21%) or resection with primary closure (60%) or pericardial patch (18%). Functional aortic annuloplasty was performed using subcommissural annuloplasty (n = 51), ascending aortic replacement (n = 17), or aortic root replacement (n = 54) using a reimplantation (76%) or remodeling technique (24%). There was no operative mortality. Five patients underwent early aortic valve reoperation (3 re-repairs). At discharge, 93% of patients had aortic insufficiency grade 0/1 and 7% of patients had grade 2. Seven additional patients underwent aortic valve reoperation during follow-up (2 re-repairs). Overall survival was 97% +/- 3% at 8 years. At 5 and 8 years follow-up, freedom from aortic valve reoperation was 94% +/- 2% and 83% +/- 5%, respectively, and freedom from aortic valve replacement was 96% +/- 2% and 90% +/- 5%, respectively. Freedom from recurrent aortic insufficiency (>2+) was 94% +/- 3% at 5 years. Freedom from thromboembolism and bleeding was 96% +/- 2% at 8 years. A systematic approach to bicuspid aortic valve repair yields good early and midterm results. Repair of bicuspid valves for aortic insufficiency is a feasible and attractive alternative to mechanical valve replacement in young patients.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1097-685X 1097-685X
DOI:	10.1016/j.jtcvs.2009.11.058