Valve-Sparing Root Replacement in Bicuspid and Tricuspid Aortic Valves: Long-Term Outcomes Into the Second Decade

Area of Science:

• Cardiovascular Surgery
• Aortic Valve Disease
• Aortic Root Aneurysm

Background:

• Valve-sparing aortic root replacement (VSRR) is a technique for aortic root aneurysms.
• Initially developed for tricuspid aortic valves (TAVs), VSRR has been extended to bicuspid aortic valves (BAVs).
• Long-term outcomes of VSRR in both TAVs and BAVs require analysis.

Purpose of the Study:

• To compare the long-term outcomes of VSRR in patients with TAVs versus BAVs.
• To identify predictors of aortic valve reintervention after VSRR.
• To assess mortality and freedom from significant aortic regurgitation (AR).

Main Methods:

• Retrospective analysis of consecutive patients undergoing VSRR from 2000 to 2023.
• Comparison of outcomes between patients with BAVs and TAVs.
• Primary endpoint: aortic valve reintervention; secondary endpoints: mortality and freedom from AR ≥2/4.

Main Results:

• 239 patients included (66 BAVs, 173 TAVs) with significant differences in demographics and indications.
• Cusp repair was more frequent in BAVs (84.8%) than TAVs (24.9%).
• After a median follow-up of 7.9 years, 16.7% of BAVs and 5.2% of TAVs required reoperation (P = .004).
• BAVs showed higher peak gradients and AR ≥2/4.
• Multivariable analysis identified BAV (HR, 3.717) and AR degree at discharge (HR, 2.745) as predictors for reoperation.

Conclusions:

• VSRR in TAVs demonstrates stable long-term outcomes with low reoperation rates (approx. 5% at 15 years).
• BAVs exhibit greater disease progression, with approximately 17% requiring early reoperation.
• Suboptimal valve function at discharge is a critical factor influencing reoperation rates in BAVs.