Stentless Valves for Bicuspid and Tricuspid Aortic Valve Disease

Abstract Background: The time course of mild aortic valve disease after replacement of the ascending aorta is unclear. We sought to clarify it.Methods: Between January 2011 and December 2016, 26 patients (9 bicuspid and 17 tricuspid aortic valve disease) underwent replacement of the enlarged ascending aorta alone. We compared the postoperative disease course between bicuspid and tricuspid aortic valve by transthoracic echocardiography and computed tomography performed at 73 ± 23 and 60 ± 23 months post-surgery, respectively.Results: The bicuspid group was younger than the tricuspid group (62.1 ± 4.8 vs 73.3 ± 4.8 years). Pathophysiology predominantly involved aortic valve stenosis and regurgitation in the bicuspid and tricuspid group, respectively. The peak and mean pressure gradient increased (P = .16, and P = .46) and the aortic valve area decreased significantly in the bicuspid group (P = .005). Two patients in the bicuspid group who required re-operation had an aortic valve area of 1.2 cm2 at initial operation. Seventy percent of patients in the tricuspid group had less than mild aortic valve regurgitation preoperatively, which improved up to 82% at follow-up. Freedom from re-operation was 66.7% and 100% at 8 years for the bicuspid and tricuspid group, respectively. Conclusions: Aortic valve replacement may be considered for patients with bicuspid aortic valve stenosis if the aortic valve area is less than 1.2 cm2, even if the general diagnosis is mild aortic valve stenosis at initial surgery. Even mild aortic valve regurgitation may be improved by surgical intervention in the ascending aorta.

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Morphological And Clinical Features Of Infective Endocarditis in Patients With Bicuspid Versus Tricuspid Aortic Valve Disease

Structural Heart ◽

10.1080/24748706.2019.1589345 ◽

2019 ◽

Vol 3 (sup1) ◽

pp. 30-30

Author(s):

Shiho Naito ◽

Hermann Reichenspurner ◽

Evaldas Girdauskas

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Clinical Features ◽

Aortic Valve Disease ◽

Valve Disease ◽

Tricuspid Aortic Valve

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Time Course of Aortic Valve Function and Root Dimensions After Subcoronary Ross Procedure for Bicuspid Versus Tricuspid Aortic Valve Disease

Circulation ◽

10.1161/circ.104.suppl_1.i-21 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Author(s):

Claudia Schmidtke ◽

Matthias Bechtel ◽

Michael Hueppe ◽

Hans-H. Sievers

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valve Disease ◽

Time Course ◽

Aortic Insufficiency ◽

Valve Disease ◽

Tricuspid Aortic Valve ◽

Group A ◽

Group B

Background The freestanding aortic root, which is the currently preferred operative technique for pulmonary autografts, is reported to dilate and potentially promote aortic insufficiency, which has led to a controversial debate on the appropriate surgical technique, especially for congenital bicuspid aortic valve disease. Desirable data on the time course of valve function and root dimensions for the alternative subcoronary technique comparing bicuspid and tricuspid aortic valve disease are scarce. Methods and Results Echocardiographic examinations of 31 patients with congenital bicuspid aortic valve disease (group A; age 50.5±11.0 years) and 51 patients with acquired tricuspid aortic valve disease (group B; age 48.1±15.7 years) who were operated on between June 1994 and August 1998 were performed twice postoperatively. At first and second follow-up, respectively, maximum (mean) pressure gradients were 6.0±2.0 (3.6±1.0) and 5.1±2.1 (2.9±1.1) mm Hg in group A and 6.5±3.5 (3.9±1.9) and 5.0±1.7 (2.9±1.0) mm Hg in group B ( P >0.05 between groups). In group A, grade 0 aortic insufficiency at first and second follow-up occurred in 8 and 7 patients, respectively, grade 0-I in 12 and 9 patients, grade I in 9 and 11 patients, grade I-II in 1 and 0 patients, and grade II in 1 and 4 patients; in group B, grade 0 aortic insufficiency occurred in 16 and 18 patients, grade 0-I in 16 and 8 patients, grade I in 17 and 21 patients, grade I-II in 0 and 1 patient, and grade II in 0 and 1 patient ( P >0.05). Aortic insufficiency decreased in 10 patients (17%). However, there was an overall tendency for aortic insufficiency to increase over time (n=23, 38%), although it remained subclinical. Aortic root dimensions did not differ between groups and were constant during follow-up. Conclusions This study provides some evidence that the function of the subcoronary pulmonary autograft in bicuspid aortic valve disease is excellent, with stable root dimensions, and is not different from that of tricuspid aortic valves at least up to 5.5 years postoperatively, which suggests the subcoronary technique should be reconsidered.

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