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Twenty-five years’ experience with root remodeling and bicuspid aortic valve repair

   
@article{ACS16950,
	author = {Lennart Froede and Karen B. Abeln and Tristan Ehrlich and Susanne K. Feldner and Hans-Joachim Schäfers},
	title = {Twenty-five years’ experience with root remodeling and bicuspid aortic valve repair},
	journal = {Annals of Cardiothoracic Surgery},
	volume = {11},
	number = {4},
	year = {2022},
	keywords = {},
	abstract = {Background: Bicuspid aortic valves may be associated with ascending aortic aneurysm, or develop severe aortic regurgitation with variable aortic dilatation. If aortic dilatation involves the root, valve-preserving root replacement is a treatment option, and we prefer root remodeling for this purpose. The objective of this study is to review our experience encompassing 25 years.
Methods:Between November 1995 and August 2021, 472 patients (429 male; age 9–80 years; mean 48±13 years) were treated by bicuspid aortic valve repair and root remodeling. Aortic regurgitation was present in 322 cases. The primary indication for surgery was aortic regurgitation (n=317), aortic aneurysm (n=143) or acute type A aortic dissection (n=12). In 271 instances, a suture annuloplasty was added. Cusp calcification was present beyond the raphe in 80 cases, and a pericardial patch was used for partial cusp replacement in 44 cases. Follow-up was 92.8% complete with a mean of 71±68 months (median 61 months).
Results: Hospital mortality was 0.4% and survival at 20 years was 76.9%. Reoperation was necessary for recurrent aortic regurgitation in 26 patients; nine patients underwent reoperation for stenosis. The overall freedom of reoperation was 90.5% after ten years and 76.6% after 20 years. Annuloplasty was associated with a higher proportion of competent aortic valves at discharge (P=0.001), and had no effect on ten-year freedom from reoperation. The use of a pericardial patch for cusp repair was a predictor for reoperation (P=0.003). The presence of cusp calcification was a predictor for the development of aortic stenosis and reoperation (P=0.032).
Conclusions: Bicuspid aortic valve repair combined with root remodeling leads to excellent ten- and 
20-year results. Cusp calcification and partial cusp replacement are associated with an increased probability of valve failure requiring reoperation.},
	issn = {2304-1021},	url = {https://www.annalscts.com/article/view/16950}
}