The clinical effect of a combined technical system for bicuspid aortic valves repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAN Wei ,  JIA Yixin , MENG Xu , JIAO Yuqing , LI Yan , HAN Jie , WANG Shengyu , CHEN Zonghao

Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, P. R. China;

Corresponding author：

JIA Yixin, Email: jason.jia@163.com

Keywords：

Bicuspid aortic valves; aortic regurgitation; repair; surgery

DOI：

10.7507/1007-4848.202108069

Video：

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Objective To summarize the clinical result of a combined technical system for bicuspid aortic valve (BAV) repair. Methods Patients who diagnosed as BAV and sever aortic regurgitation (AR) underwent a strategy of combined repair technics including annuloplasty, sinus plasty, leaflet plasty, sinus-tubular junction (STJ) plasty depending on anatomy pathological characteristics between October 2019 and January 2021 were enrolled. The clinical data of the patients were analyzed.Results A total of 17 patients were enrolled. There were 11 males and 6 females with an average age of 18-49 (32.4±13.6) years. Fifteen patients had typeⅠand 2 patients had typeⅡBAV according to Sievers classification. Annuloplasty was applicated in 13 patients, sinus plasty in 8 patients, leaflet plasty in 17 patients, and STJ plasty in 11 patients, respectively. The cardiopulmonary bypass (CPB) time was 95 (84, 135) min, aortic cross-clamping time was 68 (57, 112) min, and the ICU stay time was 17 (12, 25) h. After the operation, mild AR was presented in 14 patients, moderate AR in 1 patient and severe AR in 2 patients. The latter 3 patients underwent second operation under CPB, after then, 1 patient had mild AR and 2 patients had moderate AR. The follow-up time was 13.1±4.6 months. At the latest follow-up, 12 patients had mild AR and 5 patients had moderate AR, and no patient had reoperation. Conclusion A combined technical system for BAV repair can be used effectively and safely with an acceptable short and middle-term result.

Citation： HAN Wei, JIA Yixin, MENG Xu, JIAO Yuqing, LI Yan, HAN Jie, WANG Shengyu, CHEN Zonghao. The clinical effect of a combined technical system for bicuspid aortic valves repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 1014-1018. doi: 10.7507/1007-4848.202108069 Copy

1.	Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
2.	Borger MA, Fedak PWM, Stephens EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Executive summary. J Thorac Cardiovasc Surg, 2018, 156(2): 473-480.
3.	Michelena HI, Desjardins VA, Avierinos JF, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation, 2008, 117(21): 2776-2784.
4.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5.	Ridley CH, Vallabhajosyula P, Bavaria JE, et al. The Sievers classification of the bicuspid aortic valve for the perioperative echocardiographer: The importance of valve phenotype for aortic valve repair in the era of the functional aortic annulus. J Cardiothorac Vasc Anesth, 2016, 30(4): 1142-1151.
6.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): 450-500.
7.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2021, 60(4): 727-800.
8.	Gocoł R, Bis J, Malinowski M, et al. Comparison of bicuspid and tricuspid aortic valve repair. Eur J Cardiothorac Surg, 2021, 59(6): 1183-1190.
9.	Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.
10.	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.
11.	Arnaoutakis GJ, Sultan I, Siki M, et al. Bicuspid aortic valve repair: Systematic review on long-term outcomes. Ann Cardiothorac Surg, 2019, 8(3): 302-312.
12.	Patlolla SH, Schaff HV, Bagameri G, et al. Natural history and outcomes of nonreplaced aortic sinuses in patients with bicuspid aortic valves. Ann Thorac Surg, 2021, S0003-4975(21): 00562-2.
13.	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.
14.	Ram D, Bouhout I, Karliova I, et al. Concepts of bicuspid aortic valve repair: A review. Ann Thorac Surg, 2020, 109(4): 999-1006.
15.	Patlolla SH, Schaff HV, Stulak JM, et al. Bicuspid aortic valve repair: Causes of valve failure and long-term outcomes. Ann Thorac Surg, 2021, 111(4): 1225-1232.
16.	Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg, 2004, 128(5): 677-683.
17.	Girdauskas E, Rouman M, Disha K, et al. Aortic dissection after previous aortic valve replacement for bicuspid aortic valve disease. J Am Coll Cardiol, 2015, 66(12): 1409-1411.
18.	Subramanian S, Borger MA. Aortic valve reconstruction: Current status. Herz, 2010, 35(2): 88-93.
19.	Schneider U, Schmied W, Aicher D, et al. Sinus plication to improve valve configuration in bicuspid aortic valve repair-early results. Ann Thorac Surg, 2017, 103(2): 580-585.

1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
2. Borger MA, Fedak PWM, Stephens EH, et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Executive summary. J Thorac Cardiovasc Surg, 2018, 156(2): 473-480.
3. Michelena HI, Desjardins VA, Avierinos JF, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation, 2008, 117(21): 2776-2784.
4. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5. Ridley CH, Vallabhajosyula P, Bavaria JE, et al. The Sievers classification of the bicuspid aortic valve for the perioperative echocardiographer: The importance of valve phenotype for aortic valve repair in the era of the functional aortic annulus. J Cardiothorac Vasc Anesth, 2016, 30(4): 1142-1151.
6. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): 450-500.
7. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2021, 60(4): 727-800.
8. Gocoł R, Bis J, Malinowski M, et al. Comparison of bicuspid and tricuspid aortic valve repair. Eur J Cardiothorac Surg, 2021, 59(6): 1183-1190.
9. Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.
10. 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.
11. Arnaoutakis GJ, Sultan I, Siki M, et al. Bicuspid aortic valve repair: Systematic review on long-term outcomes. Ann Cardiothorac Surg, 2019, 8(3): 302-312.
12. Patlolla SH, Schaff HV, Bagameri G, et al. Natural history and outcomes of nonreplaced aortic sinuses in patients with bicuspid aortic valves. Ann Thorac Surg, 2021, S0003-4975(21): 00562-2.
13. 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.
14. Ram D, Bouhout I, Karliova I, et al. Concepts of bicuspid aortic valve repair: A review. Ann Thorac Surg, 2020, 109(4): 999-1006.
15. Patlolla SH, Schaff HV, Stulak JM, et al. Bicuspid aortic valve repair: Causes of valve failure and long-term outcomes. Ann Thorac Surg, 2021, 111(4): 1225-1232.
16. Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg, 2004, 128(5): 677-683.
17. Girdauskas E, Rouman M, Disha K, et al. Aortic dissection after previous aortic valve replacement for bicuspid aortic valve disease. J Am Coll Cardiol, 2015, 66(12): 1409-1411.
18. Subramanian S, Borger MA. Aortic valve reconstruction: Current status. Herz, 2010, 35(2): 88-93.
19. Schneider U, Schmied W, Aicher D, et al. Sinus plication to improve valve configuration in bicuspid aortic valve repair-early results. Ann Thorac Surg, 2017, 103(2): 580-585.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The clinical effect of a combined technical system for bicuspid aortic valves repair

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