ObjectiveTo compare the recent and mid-term results of two different treatments in bicuspid aortic valve (BAV) patients with dilated ascending aorta. MethodsFrom march 2007 to April 2014, there were totally 70 BAV patients received surgical treatment in Nanjing Cardiovascular Disease Hospital. According to the procedure of the ascending aorta, they were divided into two groups. As for group A which repaired the ascending aorta, there were 28 males and 9 females with an average age of 58.68±8.01 years. As for group B which replaced the ascending aorta, there were 25 males and 8 females with an average age of 54.18±11.97 years. And we compared perioperative clinical data and follow-up results of these two groups. ResultsThere were statistical differences between the two groups in cardiopulmonary bypass time, aortic cross clamping time, and ICU stay time (105.19±11.17 min vs. 180.94±32.10 min, P=0.000; 78.65±13.18 min vs. 110.24±29.64 min, P=0.000; 1.62±1.09 d vs. 3.58±2.89 d, P=0.001). And the time of the group A is shorter than that in the group B. Two patients in the group B died postoperatively, and the other 68 patients discharged. There was no significant difference in cumulative survival rate between the two groups (P=0.582). Postoperative following-up results showed that the ascending aortic diameter of both groups was smaller than that during the preoperative period. And at the latest time of the following-up, ascending aortic diameter was increased compared with pre-discharge in the group A (38.50±1.77 mm vs. 34.85±1.53 mm, P=0.007). But there was no increase in the group B. ConclusionWe suggests simultaneous treatment to dilated ascending aorta for BAV patients. Both the repair and replacement procedure could achieve satisfactory recent and mid-term results.
ObjectiveTo analyze the clinical characteristics and surgical treatment of bicuspid aortic valve combined with thoracic aortic dilation. MethodsWe retrospectively analyzed the clinical data of 68 patients of bicuspid aortic valve combined with thoracic aortic dilation underwent surgical treatment in our hospital between January 2010 and June 2014. There were 47 males and 21 females at age of 26-77(44.5±16.3) years. Different surgical treatments including Wheat procedure(n=22), aortic valve replacement+ascending aortoplasty(n=10), Bentall procedure(n=13), aortic valve replacement+ascending aortic replacement+right hemi aortic arch replacement(n=13), Bentall procedure+ascending aortic replacement+right hemi aortic arch replacement(n=8), Bentall procedure+ascending aortic replacement+total arch replacement+stented elephant trunk(n=2) were carried out according to the type. ResultsAll 68 patients underwent surgical treatment. The mortality in hospital is at 4.4%(3/68). The postoperative complications were neurological and mental complications(n=3), pneumonia(n=2), and exploratory thoracotomy(n=2). We followed up 63 patients for 6 months to 4 years. A total of 62 patients were well without reoperation except one death at the end of following-up 2 years. ConclusionBicuspid aortic valve combined with thoracic aortic dilation has diversiform clinical characteristics. The surgical treatment should be chosen according to the aortic valve and thoracic aortic lesion characteristics.
ObjectiveTo assess clinical results of aortic cusps replacement with bovine pericardium for bicuspid aortic valve (BAV) and severe aortic regurgitation (AR). MethodsClinical data of 79 patients with BAV and severe AR who underwent aortic cusps replacement with bovine pericardium in Wuhan Asia Heart Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 60 male and 19 female patients with their age of 38±14 years (ranged 12-78 years). All the patients were in NYHA class Ⅱ. There were 26 patients with ascending aorta and sinotubular expanding. ResultsNo early death or major complication was recorded. Intraoperative transesophageal echocardiography showed successful repair with normal coaptation of the aortic leaflets in all the patients. AR grade was less than mild in all the patients with peak aortic valve pressure gradients of 14.2±2.8 mm Hg. All the patients were discharged from the hospital within 15 postoperative days without any adverse symptom, and were followed up for 50±16 months (ranged 9-64 months). During follow-up, all the patients were in NYHA classⅠ. There were 57 patients without AR, 16 patients with mild AR, 5 patients with moderate AR and 1 patients with severe AR. The peak of aortic valve pressure gradient was 12.4±3.2 mm Hg. The average diameter of ascending aorta was 2.7 cm in the patients with ascending aorta and sinotubular expanding. The shape of sinotubular kept normal. The height of coaptation of aortic valve was 0.58 cm by echocadiography. None of the patients died or required reoperation. The structural valve degeneration was not observed during the follow-up. ConclusionThree aortic cusps replacement with bovine pericardium can produce good hemodynamics and midterm results for patients with BAV and severe AR. The ascending aorta and sinotubular should be reduced and fixed in the patients with ascending aorta and sinotubular expanding.
ObjectiveTo find the relationship between bicuspid aortic valve (BAV) and the dilatation or aneurysm of the aorta using electrocardiogram-gated computed tomography angiography (CTA). MethodsWe collected the clinical data of the BAV coexisting with suspected aortic dilatation or aneurysm from February 2012 through April 2015. A total of 124 patients were analyzed retrospectively. There were 97 males and 27 females at an anverage age of 50.35±16.26 years. According to the CTA, patients were classified into two groups: a pure BAV(without raphe) group and a BAV (with raphe) group. we recorded the aortic diameters, gender, age, and so on. ResultsOf the 124 patients, 91 (73.4%) had BAV with raphe, and 33 patients (26.6%) had pure BAV. The analysis revealed that the diameter of the annulus (23.90±3.34 mm vs. 21.74±3.46 mm, P=0.005), the sinuses of Valsalva (40.93±6.78 mm vs. 37.35±7.06 mm, P=0.022), the tubular portion of the ascending aorta (45.38±7.66 mm vs. 38.29±8.18 mm, P=0.0001), and the part of the aorta proximal to the innominate artery (34.19±4.98 mm vs. 30.23±6.62 mm, P=0.02) between patients with BAV with raphe and pure BAV had significant differences. And there was a significant difference in prevalence of dilatation of the aorta between patients with pure BAV and BAV with raphe [77/91 (84.6%) vs.18/31(58.1%), P=0.004]. Of the 91 BAV with raphe patients, we found 76 patients (83.5%) with right and left coronary cusps (R-L) fusion, 13 patients (14.3%) with right and non-coronary cusps (R-N) fusion, and 2 patients (1.2%) with left and non-coronary cusps (L-N) fusion. There was a statistical difference in the aortic root diameters between R-L fusion BAV and R-N fusion BAV. The diameter of the distal ascending aorta and proximal aortic arch between R-L and R-N fusion BAV had statistical differences. ConclusionsBAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Otherwise R-L fusion BAV is associated with increased diameters of the aortic root, while R-N fusion BAV is associated with increased diameters of the distal ascending aorta and proximal arch.
Objective To compare the efficacy and safety of transcatheter aortic valve replacement (TAVR) in aortic stenosis patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV). Methods This retrospective study included 252 consecutive patients with severe and symptomatic aortic valve stenosis undergoing TAVR in West China Hospital form April 2012 to September 2017, in whom 4 patients were excluded because of valve failure after surgical aortic valve replacement. Results Of the 248 patients, 131 had BAV and 117 had TAV. Baseline characteristics were similar between the two groups, including age [(73.56±6.35) vs. (74.31±6.35) years, P=0.354], male proportion (51.9% vs. 63.2%, P=0.072). Society of Thoracic Surgeons score for BAV patients was lower than that for TAV patients [(7.56±4.01)% vs. (8.78±5.14)%, P=0.037]. Procedural success rate was high in both BAV and TAV groups (95.4% vs. 98.3%, P=0.359). There was no difference in 30-day all-cause mortality (6.1% vs. 2.6%, P=0.176) between the two groups; the aortic valve maximum velocity of valve hemodynamics after TAVR was similiar [(2.39±0.53) vs. (2.31±0.45) m/s, P=0.262] between the two groups. Conclusions Patients with BAV show similar procedural and clinical outcomes to patients with TAV. Therefore, TAVR appears to be a safe and effective procedure for patients with BAV as well as those with TAV.
Transcatheter aortic valve replacement (TAVR) is a mature technology. Because of the complicated valvular anatomy and the severe non-symmetrical valve calcification, the patient with bicuspid aortic valve stenosis (BAVs) once having a lower procedure successful rate, was considered as the relative contradiction for TAVR. However, with the application of the skirted and retrievable next generation prosthesis system, the outcomes of the treatment have been greatly improved. In this article, we summarized the current situation of TAVR applied in BAVs, and the outcomes difference of the old and new generation prosthesis systems.
Transcatheter aortic valve replacement (TAVR) developed rapidly since firstly introduced to clinical practice in 2002. In 2015, Experts Consensus for Transeatheter Aortic Valve Replacement (abbreviated as the Consensus) helped TAVR develop normatively and safely in China. This article interpreted the Consensus in combination of new evolutions of TAVR field: first, the indications of TAVR expand from inoperative and high risk patients to the intermediate risk patients; second, although the Consensus recommended pre-dilation with balloon of modest size, the necessity of pre-dilation is under debate; third, the Consensus pointed out main complications of TAVR, and the main strategies to avoid complications are careful pre-procedural analysis and development of new device; fourth, our experts had made outstanding contribution to TAVR in the treatment of patients with bicuspid aortic valve, which still has many problems to be solved urgently.
A 78-year-old female patient was admitted to West China Hospital of Sichuan University because of “amaurosis and polypnea for 4+ years”. The examination results before admission showed that severe stenosis of aortic valve, bicuspid aortic valve malformation, severe horizontal heart with 61.54° aortic angle. The preoperative evaluation of the patient indicated that the Society of Thoracic Surgeons score was 17.9%, which was high risk for surgery. After discussion by the heart team, the aortic stenosis was finally relieved by transcatheter aortic valve replacement. The operation was successfully completed by using the method of pulling and releasing the device with the same side basket. One month follow-up showed that the patient’s condition was stable and no complications occurred. This case aims to provide a reference for the treatment of horizontal heart with aortic stenosis. In the future, it is hoped that through continuous clinical practice, such patients will be provided with a safer and more efficient treatment plan.
Due to the lack of calcification of the aortic valve, it is difficult to provide effective support for the fixation of artificial valve in aortic stenosis characterized by leaflet thickening. There is a risk of postoperative perivalvular leakage and secondary valve implantation, which is widely regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR). But aortic valvuloplasty and self-expanding transcatheter aortic valve has showed its safety and efficacy. This paper reports a patient with bicuspid aortic valve characterized by leaflet thickening treated with TAVR. After the operation, the patient’s symptom of exertional dyspnea was significantly improved, New York Heart Association class increased to Ⅱ, no perivalvular leakage was found, and the mean transaortic pressure gradient and the maximum aortic valve velocity decreased significantly.
ObjectiveTo explore the preoperative evaluation result of multidetector computed tomography (MDCT) in aortic stenosis (AS) patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR) in order to summarize relevant experience.MethodsA total of 33 consecutive AS patients who underwent TAVR in Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University from March 2016 to June 2020 were enrolled, and the preoperative evaluation characteristics of MDCT were compared between tricuspid aortic valve (TAV) and BAV.ResultsIn the 33 patients, whose mean age was (74±6) years, 22 were male and 11 were female, 17 were with BAV and 16 were with TAV. The medium (lower quartile, upper quartile) of calcification score was 360 (192, 1 034) mm3. There were 12 cases of artificial valve model to be speculated Downsize, including 9 calcific BAV cases (75%).ConclusionThe calcific BAV has a higher ratio of Downsize in the TAVR procedure.