Sinus Plication to Improve Valve Configuration in Bicuspid Aortic Valve Repair-Early Results

Previous experience with repair of the regurgitant bicuspid aortic valve (BAV) has shown a strong influence of commissural orientation on repair durability. We have modified commissural orientation by asymmetric plication of the fused sinuses. We analyzed the results of the modified technique.

Between 2009 and 2014, 35 patients with BAV and commissural orientation of no more than 160° underwent aortic valve repair, including plication of the fused sinuses and circular annuloplasty. The control group consisted of 21 historic controls undergoing operations between 2000 and 2008 but without sinus plication; subcommissural plication was used as annuloplasty. The groups were similar in most respects; differences existed in preoperative annular diameter, prevalence of complete fusion, use of a pericardial patch, and plication of the fused cusp.

At discharge the degree of aortic regurgitation (AR) was significantly lower in the study group (p = 0.004). Survival after 5 years was 100% in the study group and 95.2% in the control group after 5 and 10 years. Five-year freedom from reoperation in the study group was 93.0% and 57.1% in the control group (p = 0.0013); freedom from valve replacement was 95.8% and 79.3% (p = 0.036). Freedom from recurrent AR grade II or higher was 67.1% in the study group and 33.3% in the control group (p = 0.0024). Mean postoperative peak gradient was significantly lower in the study group (14.3 ± 6.5 mm Hg versus 28.9 ± 18.5 mm Hg, p = 0.003).

Plicating the fused sinuses and thus reducing root circumference in the fused part changes commissural orientation of the BAV which leads to better short- and midterm stability in BAV repair.