Application of reimplantation in the treatment of bicuspid aortic valve with aortic root aneurysm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GONG Xiangfeng ¹ , NIU Hao ¹ , QIN Chaoyi ¹ , SONG Haibo ² , MENG Wei ¹ , WU Zhong ¹ , GUO Yingqiang ¹ , HU Jia ¹ , ZHANG Eryong ¹ ,  XIAO Zhenghua ¹

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

XIAO Zhenghua, Email: xiaozhenghua@wchscu.cn

Keywords：

Bicuspid aortic valve; aortic root aneurysm; root reimplantation; aortic regurgitation

DOI：

10.7507/1007-4848.202201030

Video：

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Objective To evaluate the early clinical effect of reimplantation in the treatment of bicuspid aortic valve (BAV) with aortic root aneurysm. Methods The clinical data of 25 patients with BAV and aortic root aneurysm[mean diameter: 45-63 (52.68±5.55) mm] undergoing reimplantation in West China Hospital from November 2019 to May 2021 were retrospectively reviewed. There were 22 males and 3 females. The mean age was 15-65 (50.00±13.10) years and body surface area was 1.79±0.23 m². Results The pathological classification of BAV malformation was confirmed during the operation: Type 0 in 3 patients and Type 1 in 22 patients. There were 12 patients undergoing cusp central plication, and 2 patients were sutured with a closed fusion crest. Postoperative valve leaflet coaptation height was 0.78±0.15 cm, and effective height was 1.27±0.19 cm. In operation, maximum aortic valve flow velocity was 1.65±0.42 m/s, pressure difference was 5.46±3.05 mm Hg, and aortic valve annulus diameter was 21.32±0.95 mm. Cardiopulmonary bypass time was 225.84±35.34 min, and aortic block time was 189.60±26.51 min. In-hospital time was 11.64±3.07 d, ICU stay time was 2.64±0.99 d, and mechanical ventilation time was 1.48±0.87 d. The follow-up time was 17.20±4.70 months, and no death or major complications occurred during the follow-up in all patients. The cardiac function of the patients significantly improved postoperatively (P≤0.05). Echocardiography suggested that 12 patients had no aortic regurgitation, 10 minor aortic regurgitation, 3 mild aortic regurgitation, and no patients with moderate or more severe regurgitation. The diameter of the aortic sinus, left ventricular end-diastolic diameter and volume decreased during the follow-up, compared to preoperative ones (P≤0.05). The maximum flow velocity of the aortic valve was 1.54±0.36 m/s, and the pressure difference was 5.17±2.38 mm Hg during the follow-up. Conclusion Reimplantation technology has a good clinical effect for highly selective BAV patients. It can effectively avoid long-term postoperative anticoagulation, but the maximum flow rate after surgery is slightly increased, which may be related to the configuration of BAV itself. While compared with valve replacement, the effect is still worthy of recognition.

Citation： GONG Xiangfeng, NIU Hao, QIN Chaoyi, SONG Haibo, MENG Wei, WU Zhong, GUO Yingqiang, HU Jia, ZHANG Eryong, XIAO Zhenghua. Application of reimplantation in the treatment of bicuspid aortic valve with aortic root aneurysm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1347-1353. doi: 10.7507/1007-4848.202201030 Copy

1.	Afzal S, Piayda K, Maier O, et al. Current and future aspects of multimodal imaging, diagnostic, and treatment strategies in bicuspid aortic valve and associated aortopathies. J Clin Med, 2020, 9(3): 662.
2.	Messner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol, 2019, 133: 76-85.
3.	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.
4.	Etz CD, Homann TM, Silovitz D, et al. Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve. Ann Thorac Surg, 2007, 84(4): 1186-1193.
5.	Sioris T, David TE, Ivanov J, et al. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg, 2004, 128(2): 260-265.
6.	Hagl C, Strauch JT, Spielvogel D, et al. Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival? Ann Thorac Surg, 2003, 76(3): 698-703.
7.	David TE, Feindel CM, Webb GD, et al. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg, 2006, 132(2): 347-354.
8.	Subramanian S, Borger MA. Aortic valve reconstruction: Current status. Herz, 2010, 35(2): 88-93.
9.	Svensson LG. Root reimplantation with leaflet repair. Semin Thorac Cardiovasc Surg, 2019, 31(2): 153-154.
10.	Klotz S, Stock S, Sievers HH, et al. Survival and reoperation pattern after 20 years of experience with aortic valve-sparing root replacement in patients with tricuspid and bicuspid valves. J Thorac Cardiovasc Surg, 2018, 155(4): 1403-1411.
11.	Kallenbach K, Baraki H, Khaladj N, et al. Aortic valve-sparing operation in Marfan syndrome: What do we know after a decade? Ann Thorac Surg, 2007, 83(2): S764-S768.
12.	Settepani F, Szeto WY, Pacini D, et al. Reimplantation valve-sparing aortic root replacement in Marfan syndrome using the Valsalva conduit: An intercontinental multicenter study. Ann Thorac Surg, 2007, 83(2): S769-S773.
13.	Birks EJ, Webb C, Child A, et al. Early and long-term results of a valve-sparing operation for Marfan syndrome. Circulation, 1999, 100(19 Suppl): Ⅱ29-Ⅱ35.
14.	Volguina IV, Miller DC, LeMaire SA, et al. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome. J Thorac Cardiovasc Surg, 2009, 137(5): 1124-1132.
15.	Erasmi AW, Stierle U, Bechtel JF, et al. Up to 7 years' experience with valve-sparing aortic root remodeling/reimplantation for acute type A dissection. Ann Thorac Surg, 2003, 76(1): 99-104.
16.	Wu J, Huang Y, Qiu J, et al. Is valve-sparing root replacement a safe option in acute type A aortic dissection? A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2019, 29(5): 766-775.
17.	Thudt M, Papadopoulos N, Monsefi N, et al. Long-term results following pericardial patch augmentation for incompetent bicuspid aortic valves: A single center experience. Ann Thorac Surg, 2017, 103(4): 1186-1192.
18.	Kunihara T, Aicher D, Rodionycheva S, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg, 2012, 143(6): 1389-1395.
19.	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.
20.	Doss M, Moid R, Wood JP, et al. Pericardial patch augmentation for reconstruction of incompetent bicuspid aortic valves. Ann Thorac Surg, 2005, 80(1): 304-307.
21.	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.
22.	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.
23.	Ouzounian M, Feindel CM, Manlhiot C, et al. Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves. J Thorac Cardiovasc Surg, 2019, 158(1): 1-9.
24.	Murashita T, Kunihara T, Shiiya N, et al. Is preservation of the aortic valve different between acute and chronic type A aortic dissections? Eur J Cardiothorac Surg, 2001, 20(5): 967-972.
25.	Svensson LG, Cooper M, Batizy LH, et al. Simplified David reimplantation with reduction of anular size and creation of artificial sinuses. Ann Thorac Surg, 2010, 89(5): 1443-1447.
26.	Svensson LG. Sizing for modified David's reimplantation procedure. Ann Thorac Surg, 2003, 76(5): 1751-1753.
27.	Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg, 2000, 119(5): 975-982.
28.	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.

1. Afzal S, Piayda K, Maier O, et al. Current and future aspects of multimodal imaging, diagnostic, and treatment strategies in bicuspid aortic valve and associated aortopathies. J Clin Med, 2020, 9(3): 662.
2. Messner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol, 2019, 133: 76-85.
3. 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.
4. Etz CD, Homann TM, Silovitz D, et al. Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve. Ann Thorac Surg, 2007, 84(4): 1186-1193.
5. Sioris T, David TE, Ivanov J, et al. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg, 2004, 128(2): 260-265.
6. Hagl C, Strauch JT, Spielvogel D, et al. Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival? Ann Thorac Surg, 2003, 76(3): 698-703.
7. David TE, Feindel CM, Webb GD, et al. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg, 2006, 132(2): 347-354.
8. Subramanian S, Borger MA. Aortic valve reconstruction: Current status. Herz, 2010, 35(2): 88-93.
9. Svensson LG. Root reimplantation with leaflet repair. Semin Thorac Cardiovasc Surg, 2019, 31(2): 153-154.
10. Klotz S, Stock S, Sievers HH, et al. Survival and reoperation pattern after 20 years of experience with aortic valve-sparing root replacement in patients with tricuspid and bicuspid valves. J Thorac Cardiovasc Surg, 2018, 155(4): 1403-1411.
11. Kallenbach K, Baraki H, Khaladj N, et al. Aortic valve-sparing operation in Marfan syndrome: What do we know after a decade? Ann Thorac Surg, 2007, 83(2): S764-S768.
12. Settepani F, Szeto WY, Pacini D, et al. Reimplantation valve-sparing aortic root replacement in Marfan syndrome using the Valsalva conduit: An intercontinental multicenter study. Ann Thorac Surg, 2007, 83(2): S769-S773.
13. Birks EJ, Webb C, Child A, et al. Early and long-term results of a valve-sparing operation for Marfan syndrome. Circulation, 1999, 100(19 Suppl): Ⅱ29-Ⅱ35.
14. Volguina IV, Miller DC, LeMaire SA, et al. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome. J Thorac Cardiovasc Surg, 2009, 137(5): 1124-1132.
15. Erasmi AW, Stierle U, Bechtel JF, et al. Up to 7 years' experience with valve-sparing aortic root remodeling/reimplantation for acute type A dissection. Ann Thorac Surg, 2003, 76(1): 99-104.
16. Wu J, Huang Y, Qiu J, et al. Is valve-sparing root replacement a safe option in acute type A aortic dissection? A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2019, 29(5): 766-775.
17. Thudt M, Papadopoulos N, Monsefi N, et al. Long-term results following pericardial patch augmentation for incompetent bicuspid aortic valves: A single center experience. Ann Thorac Surg, 2017, 103(4): 1186-1192.
18. Kunihara T, Aicher D, Rodionycheva S, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg, 2012, 143(6): 1389-1395.
19. 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.
20. Doss M, Moid R, Wood JP, et al. Pericardial patch augmentation for reconstruction of incompetent bicuspid aortic valves. Ann Thorac Surg, 2005, 80(1): 304-307.
21. 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.
22. 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.
23. Ouzounian M, Feindel CM, Manlhiot C, et al. Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves. J Thorac Cardiovasc Surg, 2019, 158(1): 1-9.
24. Murashita T, Kunihara T, Shiiya N, et al. Is preservation of the aortic valve different between acute and chronic type A aortic dissections? Eur J Cardiothorac Surg, 2001, 20(5): 967-972.
25. Svensson LG, Cooper M, Batizy LH, et al. Simplified David reimplantation with reduction of anular size and creation of artificial sinuses. Ann Thorac Surg, 2010, 89(5): 1443-1447.
26. Svensson LG. Sizing for modified David's reimplantation procedure. Ann Thorac Surg, 2003, 76(5): 1751-1753.
27. Capps SB, Elkins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg, 2000, 119(5): 975-982.
28. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of reimplantation in the treatment of bicuspid aortic valve with aortic root aneurysm

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