Bicuspid aortic valve repair adapted to aortic phenotype

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Aortic Valve Disease

Background:

• Bicuspid aortic valve (BAV) is the most common congenital heart defect, often involving aortic root or ascending aorta dilation.
• Standardized BAV repair strategies incorporating aortic annuloplasty are needed for different proximal aorta phenotypes.
• The study evaluated a cohort of 191 patients undergoing BAV repair with various annuloplasty techniques.

Discussion:

• A systematic approach to aortic annuloplasty, tailored to dilated aortic root, dilated ascending aorta, or normal proximal aorta phenotypes, was implemented.
• Long-term outcomes demonstrated high freedom from aortic valve (AV)-related re-intervention with remodeling and tubular aortic replacement combined with annuloplasty.
• Comparison of isolated aortic insufficiency (AI) repairs highlighted superior outcomes with double sub- and supra-valvular (STJ) annuloplasty compared to single subvalvular rings.

Key Insights:

• Restoring the annulus: sinotubular junction (STJ) ratio is a critical determinant of bicuspid aortic valve repair longevity.
• Remodeling with annuloplasty achieved 98% freedom from AV-related re-intervention at 8 years.
• Double sub- and supra-valvular (STJ) annuloplasty resulted in 100% freedom from AV-related re-intervention at 6 years in isolated AI cases.

Outlook:

• Further research should focus on refining annuloplasty techniques to optimize BAV repair durability.
• Investigating the long-term impact of STJ ratio restoration on BAV function and patient survival is warranted.
• This standardized approach offers a promising strategy for improving outcomes in patients with bicuspid aortic valve anomalies.