Are bicuspid aortic valves a limitation for aortic valve repair?

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
CC Badiu ◽  
S Bleiziffer ◽  
W Eichinger ◽  
I Zaimova ◽  
A Hutter ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Bicuspid Aortic Valves

Are bicuspid aortic valves a limitation for aortic valve repair?

2011 ◽  
Author(s):  
Catalin C. Badiu ◽  
Sabine Bleiziffer ◽  
Walter B. Eichinger ◽  
Iva Zaimova ◽  
Andrea Hutter ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Bicuspid Aortic Valves

Aortic valve neocuspidization (the Ozaki procedure)

2021 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Autologous Pericardium ◽  
Bicuspid Aortic Valves

Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic valvulopathies of various entities (aortic stenosis, aortic regurgitation, aortic valve endocarditis) in both tricuspid and bicuspid aortic valves. Thus, aortic valve neocuspidization with fixed autologous pericardium represents a versatile alternative to complex aortic valve repair, with better hemodynamics compared to biological aortic valve replacement and without the need for lifelong anticoagulation, which characterizes mechanical aortic valve replacement. The authors meticulously describe all the technical steps of this highly reproducible, standardized procedure.

Techniques of Aortic Valve Repair

2011 ◽  
Vol 6 (6) ◽  
pp. 348-354 ◽  
Author(s):  
J. Scott Rankin ◽  
Jeffrey G. Gaca
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Free Edge ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Mitral Repair ◽  
Cavitron Ultrasonic Surgical Aspirator ◽  
Valve Reconstruction

Similar to mitral repair, newer methods of aortic valve reconstruction are achieving excellent outcomes with an 85% to 90% freedom from valve-related complications at 10 years. The goal of this review is to illustrate these newer and more stable techniques of aortic valve repair. Most patients with aortic insufficiency from either trileaflet or bicuspid aortic valves are candidates for repair, in addition to selected patients with mixed aortic stenosis/insufficiency and aortic root aneurysms. Initially, aggressive commissural annuloplasty is performed to reduce measured valve diameter to 19 to 21 mm. Leaflet prolapse is corrected with plication stitches placed in the free edge of each leaflet adjacent to the Nodulus Arantius. In this regard, the leaflet free edge functions as the chorda tendinea of the aortic valve, and shortening with plication stitches raises the leaflet to a proper “effective height.” Leaflet defects are augmented with gluteraldehyde-fixed autologous pericardium, and mild-to-moderate strategically placed spicules of calcium are removed with the cavitron ultrasonic surgical aspirator. Using these methods, most insufficient aortic valves, and many with mixed lesions, can be satisfactorily repaired. Six cases are illustrated in this review, spanning the spectrum of pathologies from annular dilatation without leaflet defects, to standard congenital bicuspid valve with prolapse, to trileaflet prolapse, to unusual bicuspid pathology with calcification, to a moderately calcified trileaflet valve with mixed lesions, and to aortic root aneurysms with severe aortic insufficiency. All valves were repaired using the techniques described above with trivial residual leak and minimal gradients. All repairs have been followed with yearly echocardiography, and valve reconstruction with these methods is now quite stable with excellent late outcomes. Most insufficient aortic valves now can undergo stable repair with minimal late valve-related complications. Greater application of aortic valve repair seems indicated.

scholarly journals Standardization of bicuspid valve repair with aortic annuloplasty provides similar results to tricuspid aortic valve repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Le Breton ◽  
E Lansac ◽  
N Amabile ◽  
N Khelil ◽  
A Berrebi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Young Patients ◽  
Ascending Aorta ◽  
Aortic Valve Repair ◽  
Long Term Results ◽  
Valve Repair ◽  
Aortic Valves ◽  
External Ring ◽  
Significant Difference

Abstract Background Bicuspid aortic valves (BAV) represent the main cause of severe dystrophic aortic insufficiency in young patients and are mostly replaced with high rates of valve-related events and altered quality of life in case of mechanical prosthesis. Valve repair is now recommended for root aneurysm and tricuspid aortic valves (TAV) when feasible. However, concerns remain regarding the long-term durability of BAV repair, compared to TAV. Purpose Our objective is to compare the long-term results of repair between TAV and BAV, in consecutive patients operated on with a standardized approach according to each phenotype of the dystrophic ascending aorta. Methods Data were prospectively collected into the multicenter international AVIATOR registry (AorticValve repair InternATiOnal Registry). Between 2003 and 2019, according to ascending aorta phenotypes, 226 patients with BAV and 309 patients with TAV underwent either isolated valve repair with external ring annuloplasty (26,2%), or root remodeling with external ring (59,4%), or a supra-coronary graft with external ring (14,4%). Results Cusp repair was performed in 95,1% patients in the BAV group and in 63,8% in the TAV group. The 30-day operative mortality was 0,93% (n=5). Mean follow-up was 5,5±4,4 years. The actuarial survival rate at 12 years was 93,2% in the BAV group and 87,8% in the TAV group (p=0,14). Freedom from reoperation at 12 years was similar between groups being 94,9% for bicuspid and 93,2% for tricuspid (p=0,75). Freedom from major adverse valve-related events at 12 years was 82,8% and 82,9% in BAV and TAV groups respectively (p=0,17). At 12 years, freedom from AI ≥Grade 2 or ≥Grade 3 was 68,7% and 94,3% for BAV and 76,5% and 94,7% for TAV group, with no significant difference (respectively p=0,16 and p=0,92). Conclusion Aortic valve repair with a standardized approach adapted to the aorta phenotype provides excellent long-term results with a low rate of valve-related events. Similar results were achieved between BAV and TAV patients. freedom from reoperation for BAV and TAV Funding Acknowledgement Type of funding source: None

Prevalence of Leaflet Defects during Aortic Valve Repair with Normal and Aneurysmal Aortic Morphology

2015 ◽  
Vol 63 (S 01) ◽  
Author(s):  
L. Weber ◽  
S. Pfeiffer ◽  
D. Mazzitelli ◽  
J. Rankin ◽  
C. Stamm ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Morphology

Quadricuspid Aortic Valve Repair Facilitated by Geometric Ring Annuloplasty

2021 ◽  
pp. 155698452110030
Author(s):  
Joseph A. McGuire ◽  
Heather K. Hayanga ◽  
Jeremiah W. Hayanga ◽  
Daniel Sloyer ◽  
Matthew Ellison ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Patient Outcomes ◽  
Systematic Approach ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Autologous Reconstruction ◽  
Quadricuspid Aortic Valve ◽  
Valve Repair ◽  
Ring Annuloplasty ◽  
Annular Geometry

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.

scholarly journals Comparison of bicuspid and tricuspid aortic valve repair

2020 ◽  
Author(s):  
Radosław Gocoł ◽  
Jarosław Bis ◽  
Marcin Malinowski ◽  
Joanna Ciosek ◽  
Damian Hudziak ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hazard Ratio ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Valve Repair ◽  
Tricuspid Aortic Valve ◽  
Valve Annulus ◽  
Annulus Diameter

Abstract   OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44–56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96–37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99–9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

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