Abstract
Objective
We investigated long-term outcomes of bicuspid aortic valve (BAV) repair, with external
annuloplasty, according to aorta phenotype.
Methods
Between 2003 and 2020, all patients with BAV operated on for aortic insufficiency
(AI) and/or aneurysm were included. Repairs included isolated AI repair with subvalvular
with or without sinotubular junction (STJ) (single or double) annuloplasty, supracoronary
aorta replacement (with or without hemiroot remodeling), and root remodeling with
external subvalvular ring annuloplasty.
Results
Among 343 patients operated, reparability rate was 81.3% (n = 279; age 46 ± 13.3 years).
At 10 years (median follow-up: 3.42 years; interquartile range, 1.1, 5.8), survival
was 93.9% (n = 8 deaths, similar to general population), cumulative incidence of reoperation
was 6.2% (n = 10), AI grade >2 was 5.8% (n = 9), and grade >1 was 23.0% (n = 30).
BAV repair stabilizing both the annulus and STJ with annuloplasty, compared with nonstabilized
STJ repair (single annuloplasty), had lower incidence of reoperation (2.6% vs 22.5%,
P = .0018) and AI grade >2 (1.2% vs 23.6%, P < .001) at 9 years. Initial commissural angle <160° was not a risk factor for reoperation,
compared with angle ≥160° if symmetrical repair was achieved (2.7% and 4.1%, respectively,
at 6 years, P = .85). Multivariable model showed that absence of STJ stabilization (odds ratio,
6.7; 95% confidence interval, 2.1-20, P = .001) increased recurrent AI, but not initial commissural angle <160° (odds ratio,
1.01; 95% confidence interval, 0.39-2.63, P = .98). Commissures adjusted symmetrically led to lower transvalvular gradient, compared
with nonsymmetrical repair (8.7 mm Hg vs 10.2 mm Hg, P = .029).
Conclusions
BAV repair, tailored to aorta phenotype, is associated with excellent durable outcomes
if both annulus and STJ are reduced and stabilized with external ring annuloplasty.
Commissural angle <160° is not associated with reoperation if symmetrical repair is
achieved.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
AI (aortic insufficiency), AV (aortic valve), AVIATOR (Aortic Valve International Registry), BAV (bicuspid aortic valve), CI (confidence interval), IQR (interquartile range), OR (odds ratio), STJ (sinotubular junction), SVD (structural valve deterioration), VSRR (valve-sparing root replacement)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 24, 2022
Accepted:
November 11,
2022
Received in revised form:
October 26,
2022
Received:
July 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Aortic annuloplasty during bicuspid aortic valve repair: “Simple is good but not simpler”(quote Einstein)JTCVS OpenVol. 13
- PreviewIn the past, it was undoubtedly an attractive concept that subvalvular annuloplasty might be sufficient for bicuspid aortic valve (BAV) repair stabilization. However, we now understand that the idea of a functional aortic annulus and its 3-dimensional characteristics requires more sustainability in its repair.
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- Commentary: Achieving “symmetrical” annular geometry during bicuspid aortic valve repairThe Journal of Thoracic and Cardiovascular Surgery
