Article

Valve Configuration Determines Long-Term Results After Repair of the Bicuspid Aortic Valve

Department of Thoracic and Cardiovascular Surgery, University Hospitals Homburg, Homburg, Germany.
Circulation (Impact Factor: 14.95). 01/2011; 123(2):178-85. DOI: 10.1161/CIRCULATIONAHA.109.934679
Source: PubMed

ABSTRACT Reconstruction of the regurgitant bicuspid aortic valve has been performed for >10 years, but there is limited information on long-term results. We analyzed our results to determine the predictors of suboptimal outcome.
Between November 1995 and December 2008, 316 patients (age, 49±14 years; male, 268) underwent reconstruction of a regurgitant bicuspid aortic valve. Intraoperative assessment included extent of fusion, root dimensions, circumferential orientation of the 2 normal commissures (>160°, ≤160°), and effective height after repair. Cusp pathology was treated by central plication (n=277), triangular resection (n=138), or pericardial patch (n=94). Root dilatation was treated by subcommissural plication (n=100), root remodeling (n=122), or valve reimplantation (n=2). All patients were followed up echocardiographically (cumulative follow-up, 1253 years; mean, 4±3.1 years). Clinical and morphological parameters were analyzed for correlation with 10-year freedom from reoperation with the Cox proportional hazards model. Hospital mortality was 0.63%; survival was 92% at 10 years. Freedom from reoperation at 5 and 10 years was 88% and 81%; freedom from valve replacement, 95% and 84%. By univariable analysis, statistically significant predictors of reoperation were age (hazard ratio [HR]=0.97), aortoventricular diameter (HR=1.24), effective height (HR=0.76), commissural orientation (HR=0.95), use of a pericardial patch (HR=7.63), no root replacement (HR=3.80), subcommissural plication (HR=2.07), and preoperative aortic regurgitation grade 3 or greater. By multivariable analysis, statistically significant predictors for reoperation were age (HR=0.96), aortoventricular diameter (HR=1.30), effective height (HR=0.74), commissural orientation (HR=0.96), and use of a pericardial patch (HR=5.16).
Reconstruction of bicuspid aortic valve can be performed reproducibly with good early results. Recurrence and progression of regurgitation, however, may occur, depending primarily on anatomic features of the valve.

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    • "It has been suggested that commissure and/or cusp configuration , including the commissural angular configuration (CAC), impacts on mid-term valve function and on reoperation risk after valve-sparing aortic root replacement (V-SARR) for BAV disease [4]. Here, we report a retrospective analysis testing this hypothesis by investigating the impact of pre-and postoperative commissural orientation angles and Sievers' BAV type on functional outcomes after the Tirone David V Stanford modification (TD V S-mod ) V-SARR procedure. "
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    ABSTRACT: OBJECTIVES A 180/180° configuration has been reported to increase repair durability after valve-sparing aortic root replacement (V-SARR) for bicuspid aortic valve (BAV) disease. We studied the impact of commissural angular configuration (CAC) and of BAV type on valve performance after V-SARR.
    Interactive Cardiovascular and Thoracic Surgery 06/2014; 19(3). DOI:10.1093/icvts/ivu123 · 1.11 Impact Factor
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    • "For example, an incomplete raphe seems to be associated with worse medium-term outcome after BAV reconstruction [11] [18]. Furthermore, BAVs of small circumferential free commissural orientation angle (<160 • ) might be associated with worse medium-term functional outcome after bicuspid aortic valve repair [11] "
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    ABSTRACT: There are numerous types of bicuspid aortic valve (BAV) configurations. Recent findings suggest that various BAV types represent different pathophysiological substrates on the aortic media level. Data imply that the BAV type is probably not related to location and extent of the aneurysm. However, BAV type is likely linked to the severity of aortic media disease. Some BAVs with raphe seem more aggressive than BAV without a raphe. Cusp fusion pattern, altered hemodynamics, and the qualitative severity of the disease in the aortic media might on the one hand share the same substrate. On the other hand, the aortopathy's longitudinal extent and location may represent a different pathophysiological substrate, probably dictated by the heritable aspects of BAV disease. The exact nature of the relation between BAV type and the aneurysm's location and extent as well as to the risk of aortic complications remains unclear. This paper reviews results of recent human and experimental studies on the significance of BAV types for local aortic media disease and location and extent of the aortopathy. We describe the known and hypothesized hemodynamic and hereditary factors that may result in aortic aneurysm formation in BAV patients.
    05/2012; 2012:735829. DOI:10.1155/2012/735829
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    • "For example, an incomplete raphe seems to be associated with worse medium-term outcome after BAV reconstruction [11] [18]. Furthermore, BAVs of small circumferential free commissural orientation angle (<160 • ) might be associated with worse medium-term functional outcome after bicuspid aortic valve repair [11] "
    [Show abstract] [Hide abstract]
    ABSTRACT: There are numerous types of bicuspid aortic valve (BAV) configurations. Recent findings suggest that various BAV types represent different pathophysiological substrates on the aortic media level. Data imply that the BAV type is probably not related to location and extent of the aneurysm. However, BAV type is likely linked to the severity of aortic media disease. Some BAVs with raphe seem more aggressive than BAV without a raphe. Cusp fusion pattern, altered hemodynamics, and the qualitative severity of the disease in the aortic media might on the one hand share the same substrate. On the other hand, the aortopathy's longitudinal extent and location may represent a different pathophysiological substrate, probably dictated by the heritable aspects of BAV disease. The exact nature of the relation between BAV type and the aneurysm's location and extent as well as to the risk of aortic complications remains unclear. This paper reviews results of recent human and experimental studies on the significance of BAV types for local aortic media disease and location and extent of the aortopathy. We describe the known and hypothesized hemodynamic and hereditary factors that may result in aortic aneurysm formation in BAV patients.
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