Abstract 13308: Preserving Well-Functioning Bicuspid Aortic Valves in Ascending Aortic Aneurysm Repair
Objectives: In patients with aortopathy requiring ascending aortic aneurysm repair in the setting of a normally functioning bicuspid aortic valve (BAV), we 1) characterized aorta and BAV morphology, 2) evaluated rate of progression to BAV regurgitation (AR) or stenosis (AS), and 3) assessed probability of late valve replacement (AVR).
Methods: From 1/1991 to 8/2011, 7,282 patients had ascending aorta surgery. Two hundred five (age 51±12 years) had a well-functioning BAV and underwent supracoronary grafting; Eighty-seven BAVs were left intact and 118 minimally repaired. Preoperative aortic dimensions, cusp fusion pattern, commissural orientation, and cusp tissue pliability were evaluated. Longitudinal progressions of AR and AS were studied echocardiographically.
Results: Mean diameters at the aortic anulus were 2.4±0.3 cm, sinus 3.8±0.49 cm, proximal arch 3.6±0.61 cm, mid-arch 2.9±0.55 cm, and maximum ascending aortic diameter 5.1±0.51 cm, with a preserved or mildly effaced sinutubular junction in 80%. Fusion of right-left coronary cusps was the most common pattern (137/173 [78%]); 94% had 1 raphe. Commissural orientation was 164°±23°. Tissue pliability was 0.53%±0.17% for reference cusps and 0.43%±0.21% for conjoint cusps. Prevalence of 3+/4+ AR reached 8.0% by 1 year after aortic surgery, then remained constant. Gradient remained constant in the range of normal to mild AS on average (Figure). At 5 and 10 years, freedom from AVR was 94% and 81% and survival 94% and 88%, respectively (Figure).
Conclusion: Preserving a well-functioning BAV during supracoronary ascending aorta surgery is safe, with low probability of severe valve dysfunction or AVR and excellent intermediate survival. This strategy might have advantages over early valve replacement. Minimal BAV repair did not add benefit in the intermediate term.
- © 2013 by American Heart Association, Inc.