Abstract 2976: Valve Configuration Determines Long-term Results After Repair of the Bicuspid Aortic Valve
Objective: Repair of the regurgitant bicuspid aortic valve (BAV) is a new approach. We attempted to identify predictors of 10-year repair stability.
Methods: Between 10/1995 and 3/2009, 316 patients with BAV (49±14y, 268 male) underwent aortic valve repair for aortic regurgitation (AR). Intraoperative assessment showed fusion of the right and left coronary cusps in most patients (281/316), fusion was complete in 194 and partial in 122. The circumferential orientation of the 2 normal commissures was >160° (n=51), 140°–160° (n=244) or <140° (n=21). Cusp pathology was treated by central plication (n=277), triangular resection (n=138) or pericardial patch (n=94). Root dilatation was treated by subcommissural plication (n=100); root remodeling (n=122) or valve reimplantation (n=2). Isolated aortic valve repair was performed in 117 individuals. Parameters analyzed for correlation with 10-year stability were: age, sex, morphology of the BAV (orientation of the commissures, site/extent of cusp fusion), root dimensions (aortoventricular [AVD]/ sinutubular diameter), cusp configuration (effective height [eH]), preoperative severity of AR and type of operation (plication, triangular resection, use of pericardial patch, subcommissural plication, root replacement). All patients were followed echocardiographically (cumulative follow-up: 1253 years). Factors influencing freedom from reoperation on the aortic valve were analyzed using Cox proportional hazards model.
Results: Freedom from reoperation was 81%, freedom from valve replacement was 84% after 10 years. Freedom from all valve-related complications was 80% after 10 years. By univariate analysis age >40 years (p=0.005); AVD <29 mm (p=0.007), eH >8 mm (p<0.0001), complete fusion (p=0.005), commissural orientation >140° (p=0.0003), absence of a pericardial patch and root replacement (p=0.0002) correlated with improved valve stability. By multivariate analysis predictors for improved valve stability were age >40 years (p=0.02); AVD <29mm (p=0.008), eH >8mm (p<0.0001) and absence of a pericardial patch.
Conclusions: Long-term stability of the repaired BAV is influenced by the technique of repair and postoperative valve and root configuration.