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(Circulation. 2001;104:I-21.)
© 2001 American Heart Association, Inc.

Surgery for Valvular Heart Disease

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

Claudia Schmidtke, MD; Matthias Bechtel, MD; Michael Hueppe, PhD; Hans-H. Sievers, MD, FETCS

Department of Cardiac Surgery (C.S., M.B., H.-H.S.) and Anesthesiology (M.H.), Medical University of Luebeck, Luebeck, Germany.

Correspondence to Prof Dr Hans-H. Sievers, Klinik für Herzchirurgie, Universitätsklinikum Lübeck, Ratzeburger Allee 160, D 23538 Lübeck, Germany. E-mail schmidtk{at}medinf.mu-luebeck.de

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.

Key Words: heart diseases • valves • pulmonary autograft