Valve-sparing aortic root replacement in bicuspid aortic valves: a reasonable option?

Area of Science:

• Cardiovascular Surgery
• Aortic Valve Disease
• Surgical Techniques

Background:

• Aortic dilatation is common in patients with bicuspid aortic valves.
• Root replacement using remodeling, initially for tricuspid valves, is adapted for bicuspid aortic valve repair.
• This study compares remodeling outcomes in bicuspid versus tricuspid aortic valves.

Purpose of the Study:

• To evaluate the efficacy of aortic root remodeling in patients with bicuspid aortic valves.
• To compare the results of root remodeling in bicuspid aortic valves with those in tricuspid aortic valves.
• To assess valve stability and hemodynamic function after repair.

Main Methods:

• Retrospective analysis of 60 patients with bicuspid aortic valves (Group A) and 130 with tricuspid aortic valves (Group B) undergoing root remodeling (Oct 1995-Jan 2004).
• Correction of cusp prolapse was more frequent in Group A.
• Transthoracic echocardiography assessed outcomes; cumulative follow-up was 527 patient-years.

Main Results:

• No mortality in Group A. Hospital mortality in Group B was 5% (elective) and 10% (emergency).
• Mean systolic gradients were similar at 1 and 5 years between groups.
• Five-year freedom from grade ≥2 aortic regurgitation was 96% (Group A) vs. 83% (Group B); freedom from reoperation was 98% in both groups.

Conclusions:

• Valve-sparing aortic replacement with root remodeling is applicable to aortic dilatation and regurgitant bicuspid aortic valves.
• Repaired bicuspid aortic valves demonstrate comparable hemodynamic function and stability to tricuspid aortic valves.
• Root remodeling is a safe and effective technique for managing aortic root dilatation in bicuspid aortic valve disease.