Aortic valve function after bicuspidization of the unicuspid aortic valve

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Cardiac Valve Repair

Background:

• Unicuspid aortic valve (UAV) anatomy often leads to dysfunction in young individuals.
• A reconstructive technique to bicuspidize the UAV was developed, with two initial designs: asymmetric (I) and symmetric (II).
• This study aimed to compare the hemodynamic function of these two bicuspidized UAV designs.

Purpose of the Study:

• To compare the hemodynamic performance of asymmetric versus symmetric bicuspid repair of unicuspid aortic valves.
• To evaluate systolic aortic valve function at rest and during exercise in patients who underwent UAV repair.

Main Methods:

• Twenty-eight patients with repaired UAV (8 asymmetric, 20 symmetric) and 6 healthy controls underwent transthoracic echocardiography.
• Systolic gradients were assessed using continuous wave Doppler at rest and during exercise (100 W).
• Patient demographics and New York Heart Association class were recorded; no significant differences were noted between groups.

Main Results:

• All patients exhibited grade I or less aortic regurgitation post-repair.
• Resting systolic gradients were significantly higher in the asymmetric repair group (Group I) compared to the symmetric repair group (Group II) and controls.
• Peak systolic gradients during exercise were also significantly higher in Group I compared to Group II and controls.

Conclusions:

• Converting a unicuspid aortic valve to a symmetric bicuspid aortic valve results in adequate valve competence.
• The symmetric bicuspid repair design demonstrates superior systolic aortic valve function at rest and during exercise compared to asymmetric repair.