100 * PREOPERATIVE AORTIC ANNULUS DIAMETER AFFECTS VALVE DURABILITY IN BICUSPID AORTIC VALVE PATIENTS UNDERGOING PRIMARY VALVE REPAIR PLUS SUBCOMMISSURAL ANNULOPLASTY FOR AORTIC INSUFFICIENCY

AbstractOBJECTIVESThe bicuspid aortic valve (BAV) exists in a wide variety of valve phenotypes. The aim of this study was to assess the anatomical characteristics of the different phenotypes and develop a classification system to aid surgical repair.METHODSIn 178 consecutive patients operated on for aortic insufficiency or aortic dilatation in 2 centres, 11 anatomical parameters of BAV were measured by echocardiography and intraoperatively. All BAV judged potentially repairable were included in the study.RESULTSCommissural orientation correlated positively with fusion length (R2 = 0.6, P < 0.001) and negatively with non-functional commissure height (R2 = 0.45, P < 0.001). The cohort was divided into 3 groups according to their commissural orientation (type A: symmetrical, 160–180°, n = 73; type B: asymmetrical, 140–159°, n = 74; and type C: very asymmetrical, 120–139°, n = 31). The patterns of cusp fusion, annulus and aortic size were similar among the groups. Fusion length and the geometric height of the cusps decreased from type A to C; non-functional commissure height increased from type A to C (P < 0.05). Patient age increased from type A to type C. Isolated aortic dilatation was more frequent in type A, and severe aortic insufficiency was more frequent in types B and C (P < 0.05). Valve repair techniques and management of commissural orientation varied among the 3 groups (P < 0.05). Aortic valve replacement and residual aortic insufficiency after repair were more frequent in type C (P < 0.05).CONCLUSIONSThe BAV phenotypes follow a continuous spectrum that extends from symmetrical to very asymmetrical BAV. We describe the main anatomical parameters (including commissure orientation, length of fusion and non-functional commissure height) and their variation across this spectrum. We propose a new repair-oriented classification system based on those parameters that can be used to predict valve repair techniques. This classification needs further validation with regards to surgical techniques and long-term outcomes.

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The Sievers Classification of the Bicuspid Aortic Valve for the Perioperative Echocardiographer: The Importance of Valve Phenotype for Aortic Valve Repair in the Era of the Functional Aortic Annulus

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2016.02.009 ◽

2016 ◽

Vol 30 (4) ◽

pp. 1142-1151 ◽

Cited By ~ 18

Author(s):

Clare H. Ridley ◽

Prashanth Vallabhajosyula ◽

Joseph E. Bavaria ◽

Prakash A. Patel ◽

Jacob T. Gutsche ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Annulus ◽

Aortic Valve Repair ◽

Valve Repair

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Bicuspid aortic valve repair in the setting of severe aortic insufficiency

Journal of Visualized Surgery ◽

10.21037/jovs.2018.04.13 ◽

2018 ◽

Vol 4 ◽

pp. 101-101 ◽

Cited By ~ 3

Author(s):

Ziv Beckerman ◽

Michael O. Kayatta ◽

LaRonica McPherson ◽

Jose N. Binongo ◽

Yi Lasanajak ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Insufficiency ◽

Aortic Valve Repair ◽

Valve Repair

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Bicuspid Aortic Valve Repair for Aortic Insufficiency Without Aortic Root Aneurysm: Does Preoperative Annular Diameter Matter for Long-term Durability?

Structural Heart ◽

10.1080/24748706.2019.1589259 ◽

2019 ◽

Vol 3 (sup1) ◽

pp. 65-65

Author(s):

Mary A. Siki

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Aortic Insufficiency ◽

Aortic Valve Repair ◽

Valve Repair ◽

Aortic Root Aneurysm

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Quadricuspid Aortic Valve Repair Facilitated by Geometric Ring Annuloplasty

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211003095 ◽

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.

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Comparison of bicuspid and tricuspid aortic valve repair

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa462 ◽

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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Ascending Aortic Replacement With Aortic Valve Reimplantation

Circulation ◽

10.1161/circ.100.suppl_2.ii-24 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Wolfgang Harringer ◽

Klaus Pethig ◽

Christian Hagl ◽

Gerd P. Meyer ◽

Axel Haverich

Keyword(s):

Aortic Valve ◽

Aortic Insufficiency ◽

Additional Patient ◽

Valve Repair ◽

Sinotubular Junction ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Ischemic Attack ◽

Aortic Valve Reimplantation

Background —Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft in patients with aortic root aneurysms corrects annular ectasia and dilatation of the sinotubular junction. The durability of this valve repair with respect to the increased mechanical stress on valve cusps has been discussed, is quite controversial, and is yet unknown. Methods and Results —From July 1993 to November 1998, a replacement of the ascending aorta with a repair of the aortic valve was performed in 75 patients (53 men and 22 women aged 50±19 years). Twenty-one patients (28%) had Marfan syndrome, and 11 patients (15%) had an aortic dissection, type Stanford A (6 acute, 5 chronic). In 17 patients (23%), concomitant replacement of the aortic arch was necessary. Clinical and echocardiographic follow-up was performed in 6- to 12-month intervals for a cumulative study period of 137 patient-years. No operative deaths occurred. Two patients (3%) died 5 and 20 months postoperatively. One additional patient experienced a transient ischemic attack within the first postoperative week. Three patients (4%) with progressive aortic insufficiency required aortic valve replacement after 9, 11, and 14 months. All other patients had no or mild aortic insufficiency. The repairs have now remained stable for ≤65 months (mean, 22±20 months). Other valve-related complications did not occur. Conclusions —Our results demonstrate that this type of aortic valve repair achieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace aortic insufficiency at initial echocardiography seems to be essential for durability.

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