Survival and reoperation risk following bicuspid aortic valve-sparing root replacement

The mid-term outcome of aortic valve-sparing root replacement, reimplanting native bicuspid versus tricuspid aortic valves, is unclear.

The records of 84 consecutive patients (66 men, 18 women; mean age 46.6 years) who had undergone aortic valve-sparing root replacement using the reimplantation technique between January 1997 and July 2006, were reviewed. Among the patients, 26 (31%) had Marfan syndrome and 14 (17%) had a bicuspid aortic valve. The mean follow up period was 4.1 years.

There were three early deaths (4%) and five late deaths (6%). Late survival (>30 days) at five and eight years was 95% and 88%, respectively. The presence of significant coronary artery disease (p = 0.001), a lower preoperative ejection fraction (p = 0.03) and older age (p = 0.04) were the only univariate predictors of death. Freedom from moderate-severe or severe (grade 3 or 4) aortic valve regurgitation at one and five years was 91% and 77%, respectively. Ten patients (12%) required aortic valve reoperation at a mean of 3.4 years after surgery (3/14 bicuspid, 7/70 tricuspid); however, only one reoperation was required among patients undergoing the initial surgery after the year 2000. Freedom from aortic valve reoperation at one and five years was 95% and 83%, respectively. The predischarge degree of aortic valve regurgitation was the sole univariate factor associated with aortic valve reoperation (p = 0.008). Bicuspid valve morphology was not a predictor of either recurrent aortic valve regurgitation, nor of aortic valve reoperation.

Bicuspid aortic valves may be safely spared by reimplantation during replacement of the aortic root, with similar mid-term durability as for tricuspid aortic valves.