Short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Busheng ¹ , DAI Huangdong ¹ , FANG Liang ¹ , XIE Xiaoyi ² , LI Wei ¹ ,  KONG Ye ¹

1. Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China;
2. Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China;

Corresponding author：

KONG Ye, Email: kongye2008@outlook.com

Keywords：

Bicuspid aortic valve; aortic regurgitation; valve repair; aortic annuloplasty; surgery

DOI：

10.7507/1007-4848.202101038

Video：

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Objective To evaluate the short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves (BAV).Methods The clinical data of 27 consecutive patients with insufficient BAV undergoing valve repair in Shanghai Chest Hospital from September 2016 to January 2020 were retrospectively reviewed. There were 24 males and 3 females with a mean age of 38.5±14.6 years (range: 20-68 years). BAV of all patients was type 1 in Seviers' classification. There were 23 patients with left-right fusion and 4 patients with right-noncoronary fusion. There was aortic regurgitation in the patients measured by the echocardiogram, including moderate regurgitation in 3 patients, moderate-severe in 18 patients, and severe in 6 patients. The diameter of aortic annular base was 27.9±3.4 mm, and the largest diameter of aortic sinus was 39.9±7.6 mm. Left ventricular end diastolic diameter was 62.7±6.5 mm, and the volume was 197.9±53.6 mL.Results All 27 patients completed the follow-up, and the mean time was 24.2±12.5 months (range: 12-51 months). No patient died or required aortic valve-related reoperation during the follow-up. The cardiac function of the patients significantly improved postoperatively (P<0.05). By echocardiography, 11 patients had no aortic regurgitation, 13 had mild aortic regurgitation, and 3 had moderate aortic regurgitation, and no patient had severe aortic regurgitation. Postoperative left ventricular end diastolic diameter and volume decreased, compared to preoperative ones (P<0.05).Conclusion In patients with insufficient BAV, valve repair is safe and effective, and has excellent short and mid-term outcomes.

Citation： ZHANG Busheng, DAI Huangdong, FANG Liang, XIE Xiaoyi, LI Wei, KONG Ye. Short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1436-1440. doi: 10.7507/1007-4848.202101038 Copy

1.	Liu T, Xie M, Lv Q, et al. Bicuspid aortic valve: An update in morphology, genetics, biomarker, complications, imaging diagnosis and treatment. Front Physiol, 2019, 9: 1921.
2.	Antoniou A, Harky A, Bashir M, et al. Why I choose to repair and not to replace the aortic valve? Gen Thorac Cardiovasc Surg, 2019, 67(1): 20-24.
3.	Casselman FP, Gillinov AM, Akhrass R, et al. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg, 1999, 15(3): 302-308.
4.	Miyahara S, Schneider U, Morgenthaler L, et al. (Almost) all nonstenotic bicuspid aortic valves should be preserved or repaired. Semin Thorac Cardiovasc Surg, 2019, 31(4): 656-660.
5.	Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med, 2017, 377(19): 1847-1857.
6.	Sharifulin R, Bogachev-Prokophiev A, Zheleznev S, et al. Factors impacting long-term pulmonary autograft durability after the Ross procedure. J Thorac Cardiovasc Surg, 2019, 157(1): 134-141.
7.	Ashikhmina E, Sundt TM, Dearani JA, et al. Repair of the bicuspid aortic valve: A viable alternative to replacement with a bioprosthesis. J Thorac Cardiovasc Surg, 2010, 139(6): 1395-1401.
8.	Aicher D, Kunihara T, Abou Issa O, et al. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation, 2011, 123(2): 178-185.
9.	Schneider U, Hofmann C, Schöpe J, et al. Long-term results of differentiated anatomic reconstruction of bicuspid aortic valves. JAMA Cardiol, 2020, 5(12): 1366-1373.
10.	Aicher D, Langer F, Kissinger A, et al. Valve-sparing aortic root replacement in bicuspid aortic valves: A reasonable option? J Thorac Cardiovasc Surg, 2004, 128(5): 662-668.
11.	Ram D, Bouhout I, Karliova I, et al. Concepts of bicuspid aortic valve repair: A review. Ann Thorac Surg, 2020, 109(4): 999-1006.
12.	Schäfers HJ, Schmied W, Marom G, et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg, 2013, 146(2): 269-274.
13.	Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg, 2006, 132(2): 436-438.
14.	Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042.
15.	Lavon K, Halevi R, Marom G, et al. Fluid-structure interaction models of bicuspid aortic valves: The effects of nonfused cusp angles. J Biomech Eng, 2018, 140(3).
16.	Navarra E, El Khoury G, Glineur D, et al. Effect of annulus dimension and annuloplasty on bicuspid aortic valve repair. Eur J Cardiothorac Surg, 2013, 44(2): 316-322.
17.	de Kerchove L, Boodhwani M, Glineur D, et al. Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg, 2011, 142(6): 1430-1438.
18.	Lansac E, Di Centa I, Raoux F, et al. An expansible aortic ring for a physiological approach to conservative aortic valve surgery. J Thorac Cardiovasc Surg, 2009, 138(3): 718-724.
19.	Schneider U, Aicher D, Miura Y, et al. Suture annuloplasty in aortic valve repair. Ann Thorac Surg, 2016, 101(2): 783-785.
20.	Karliova I, Schneider U, Ehrlich T, et al. Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg, 2020, 109(3): 728-735.
21.	de Kerchove L, Mastrobuoni S, Froede L, et al. Variability of repairable bicuspid aortic valve phenotypes: Towards an anatomical and repair-oriented classification. Eur J Cardiothorac Surg, 2019: ezz033.

1. Liu T, Xie M, Lv Q, et al. Bicuspid aortic valve: An update in morphology, genetics, biomarker, complications, imaging diagnosis and treatment. Front Physiol, 2019, 9: 1921.
2. Antoniou A, Harky A, Bashir M, et al. Why I choose to repair and not to replace the aortic valve? Gen Thorac Cardiovasc Surg, 2019, 67(1): 20-24.
3. Casselman FP, Gillinov AM, Akhrass R, et al. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg, 1999, 15(3): 302-308.
4. Miyahara S, Schneider U, Morgenthaler L, et al. (Almost) all nonstenotic bicuspid aortic valves should be preserved or repaired. Semin Thorac Cardiovasc Surg, 2019, 31(4): 656-660.
5. Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med, 2017, 377(19): 1847-1857.
6. Sharifulin R, Bogachev-Prokophiev A, Zheleznev S, et al. Factors impacting long-term pulmonary autograft durability after the Ross procedure. J Thorac Cardiovasc Surg, 2019, 157(1): 134-141.
7. Ashikhmina E, Sundt TM, Dearani JA, et al. Repair of the bicuspid aortic valve: A viable alternative to replacement with a bioprosthesis. J Thorac Cardiovasc Surg, 2010, 139(6): 1395-1401.
8. Aicher D, Kunihara T, Abou Issa O, et al. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation, 2011, 123(2): 178-185.
9. Schneider U, Hofmann C, Schöpe J, et al. Long-term results of differentiated anatomic reconstruction of bicuspid aortic valves. JAMA Cardiol, 2020, 5(12): 1366-1373.
10. Aicher D, Langer F, Kissinger A, et al. Valve-sparing aortic root replacement in bicuspid aortic valves: A reasonable option? J Thorac Cardiovasc Surg, 2004, 128(5): 662-668.
11. Ram D, Bouhout I, Karliova I, et al. Concepts of bicuspid aortic valve repair: A review. Ann Thorac Surg, 2020, 109(4): 999-1006.
12. Schäfers HJ, Schmied W, Marom G, et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg, 2013, 146(2): 269-274.
13. Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg, 2006, 132(2): 436-438.
14. Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg, 2017, 153(5): 1033-1042.
15. Lavon K, Halevi R, Marom G, et al. Fluid-structure interaction models of bicuspid aortic valves: The effects of nonfused cusp angles. J Biomech Eng, 2018, 140(3).
16. Navarra E, El Khoury G, Glineur D, et al. Effect of annulus dimension and annuloplasty on bicuspid aortic valve repair. Eur J Cardiothorac Surg, 2013, 44(2): 316-322.
17. de Kerchove L, Boodhwani M, Glineur D, et al. Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg, 2011, 142(6): 1430-1438.
18. Lansac E, Di Centa I, Raoux F, et al. An expansible aortic ring for a physiological approach to conservative aortic valve surgery. J Thorac Cardiovasc Surg, 2009, 138(3): 718-724.
19. Schneider U, Aicher D, Miura Y, et al. Suture annuloplasty in aortic valve repair. Ann Thorac Surg, 2016, 101(2): 783-785.
20. Karliova I, Schneider U, Ehrlich T, et al. Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg, 2020, 109(3): 728-735.
21. de Kerchove L, Mastrobuoni S, Froede L, et al. Variability of repairable bicuspid aortic valve phenotypes: Towards an anatomical and repair-oriented classification. Eur J Cardiothorac Surg, 2019: ezz033.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves

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