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(Circulation. 2006;114:I-610 – I-616.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Repair of Bicuspid Aortic Valves in Patients With Aortic Regurgitation

Gébrine El Khoury, MD; Jean-Louis Vanoverschelde, MD, PhD; David Glineur, MD; Frédéric Pierard, MD; Robert R. Verhelst, MD; Jean Rubay, MD, PhD; Jean-Christophe Funken, MD; Christine Watremez, MD; Parla Astarci, MD; Valérie Lacroix, MD; Alain Poncelet, MD; Philippe Noirhomme, MD

From the Departments of Cardiovascular and Thoracic Surgery, Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Public Health School, Université Catholique de Louvain, Brussels, Belgium.

Correspondence to Gebrine El Khoury, Service de Chirurgie Cardiovasculaire et Thoracique, Cliniques Universitaires Saint-Luc, U.C.L.90, Avenue Hippocrate 10/6107, B-1200 Bruxelles, Belgium. E-mail Elkhoury{at}chir.ucl.ac.be

Background— Bicuspid aortic valve regurgitation can be caused by a defect in the valve itself or by dysfunction of one or more components of the aortic root complex. A successful repair thus requires correction of all aspects of the problem simultaneously. We review our experience addressing both the valve and the aortic root when correcting bicuspid valve regurgitation.

Methods and Results— Between 1996 and 2004, we treated 68 patients for aortic regurgitation. Thirty patients had isolated aortic regurgitation, and 38 had an associated ascending aortic aneurysm. All patients were treated using a standardized and integrated surgical technique, which included resection of the median raphe or leaflet plication, subcommissural annuloplasty, reinforcement of the leaflet free edge, and sinotubular junction plication. In the 38 patients with proximal aortic dilatation, reimplantation or remodeling of the aortic root was performed. Immediate postoperative echocardiography showed grade 1 aortic regurgitation in all patients. Three patients nonetheless needed an early re-operation because of recurrent regurgitation. No hospital mortality was observed. At a mean follow-up of 34 months after surgery, all patients were in New York Heart Association (NYHA) class 1 or 2. Two patients needed a re-operation (23 and 92 months, respectively). Echocardiographic follow-up showed no progression of the regurgitation in 58 surviving patients. Four patients progressed to grade 2 regurgitation.

Conclusion— Our data indicate that regurgitant bicuspid aortic valves, whether alone or in association with a proximal aortic dilatation, can be repaired successfully provided that both the valve and the aortic root problems are treated simultaneously.

Key Words: aortic insufficiency • aortic valve repair • bicuspid aortic valve