Bicuspid Morphology and Rapid Deployment Valve Replacement: Is This Still a Contraindication?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Heart Valve Disease

Background:

• Bicuspid aortic valve (BAV) morphology presents challenges for rapid deployment surgical aortic valve replacement (RD SAVR) due to annular asymmetry.
• The Sievers classification is traditionally used to describe BAV morphology.

Purpose of the Study:

• To retrospectively analyze the feasibility and outcomes of RD SAVR in patients with BAV morphology, stratified by Sievers classification.
• To evaluate the safety and efficacy of RD SAVR across different BAV morphologies.

Main Methods:

• Retrospective analysis of 31 patients with BAV morphology (15 Sievers type 0, 16 Sievers type 1) who underwent RD SAVR between January 2014 and March 2022.
• Application of specific surgical techniques tailored to BAV morphology.
• Comparison of clinical outcomes, procedural times, prosthesis sizes, and postoperative results between Sievers types.

Main Results:

• Comparable clinical outcomes were observed between Sievers type 0 and type 1 BAV groups.
• No significant differences in paravalvular leaks, re-interventions, cardiopulmonary bypass (CPB) and cross-clamping times, or prosthesis sizes.
• Similar postoperative mean gradients, pacemaker indications, stroke rates, and mortality.
• Effective restoration of annular symmetry through precise prosthesis placement irrespective of Sievers classification.

Conclusions:

• RD SAVR is a safe and feasible approach for all bicuspid aortic valve morphologies, including those classified by Sievers.
• The procedure yields good hemodynamic results and offers time-saving potential when performed by experienced surgeons.
• Precise prosthesis sizing and placement, guided by individual valve morphology, are key to successful outcomes.