Haemodynamic early outcomes of sinus plication for bicuspid aortic valve repair

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Bicuspid aortic valve (BAV) with moderate-severe aortic regurgitation (n=41). Intervention: Sinus plication vs. No sinus plication. Primary outcome: Transvalvular peak pressure gradient at 1 year (mmHg).

Q: What does this research mean for the field?

Sinus plication during bicuspid aortic valve repair is associated with lower peak pressure gradient and maximum velocity at 1 year, potentially enhancing haemodynamic stability. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kay Maeda; Nao Ichihara; Toshio Baba; Tomonobu Abe; Atsushi Yamaguchi; Dai Une; Mikizou Nakai; Hiroshi Matsuura; T. Fujii; Takashi Kunihara

doi:10.1093/icvts/ivag103

April 9, 2026Interdisciplinary CardioVascular and Thoracic SurgeryOpen Access

Haemodynamic early outcomes of sinus plication for bicuspid aortic valve repair

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Key result

Sinus plication during BAV repair linked to lower 1-year peak pressure gradients and maximum velocities.

n=41

Figures

Graphical abstract published by Interdisciplinary CardioVascular and Thoracic Surgery — Graphical abstract · Published by Interdisciplinary CardioVascular and Thoracic Surgery · CC BY

Why the study?

Postoperative stenosis negatively affects durability after bicuspid aortic valve valvuloplasty, and the haemodynamic efficacy of sinus plication to avoid stenosis after asymmetrical BAV repair was evaluated.

Does sinus plication improve haemodynamic outcomes at 1 year in patients undergoing bicuspid aortic valve repair for moderate-severe aortic regurgitation?

Key Points

To evaluate the hemodynamic efficacy of sinus plication in preventing postoperative stenosis after asymmetrical bicuspid aortic valve repair.
Comparative cohort study of 41 patients (mean age 33.3 ± 11.5 years; 40 males) with moderate-to-severe aortic regurgitation undergoing bicuspid aortic valve repair between 2018 and 2023.
Patients received repair with sinus plication to restore sinus symmetry (n = 14) or without sinus plication (n = 27).
Hemodynamic variables were evaluated preoperatively, at discharge, and at 1-year follow-up using transthoracic echocardiography.
Zero mortality occurred at 1 year in either group, with both cohorts achieving well-controlled aortic regurgitation and adequate left ventricular reverse remodeling.
At 1 year, the sinus plication group exhibited lower transvalvular peak pressure gradient (17.7 ± 5.5 mmHg; % change -8.8% ± 1.1%) and lower maximum velocity (1.9 ± 0.31 m/s; % change -13.1% ± 2.1%) compared to the non-plication group (peak pressure gradient 24.7 ± 9.6 mmHg; % change +8.8% ± 1.3%; maximum velocity 2.58 ± 0.62 m/s; % change +9.3% ± 2.5%).
No clear differences in percentage changes of peak pressure gradient or maximum velocity remained between groups after adjusting for baseline covariates.

Study Design

Type

Cohort (n=41)

Structured PICO

Does sinus plication improve haemodynamic outcomes at 1 year in patients undergoing bicuspid aortic valve repair for moderate-severe aortic regurgitation?

P

Population

41 patients (mean age 33.3 years, 2.4% female) with bicuspid aortic valve and moderate-severe aortic regurgitation undergoing aortic valve repair, followed for 1 year.

E

Exposure

Aortic valve repair with sinus plication (SP) to reduce the circumference of the fused sinus and restore sinus contour symmetry (n=14).

C

Comparator

Aortic valve repair without sinus plication (NSP) (n=27).

O

Outcome

Haemodynamic parameters (transvalvular peak pressure gradient and maximum transvalvular flow velocity) assessed at discharge and 1 year using transthoracic echocardiography.surrogate

Main Result

Absolute Event Rate: 17.7% vs 24.7%

Sinus plication during bicuspid aortic valve repair may enhance haemodynamic stability by lowering peak pressure gradients and maximum flow velocities at 1 year.

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Implication

May support sinus plication in BAV repair; leaves open haemodynamic benefit pending randomized confirmation before practice change.

Abstract

OBJECTIVES: Postoperative stenosis negatively affects durability after bicuspid aortic valve (BAV) valvuloplasty. This study was performed to evaluate the haemodynamic efficacy of sinus plication (SP) to avoid stenosis after asymmetrical BAV repair. METHODS: Between 2018 and 2023, 41 patients with BAV (33.3 ± 11.5 years, 40 males) with moderate-severe aortic regurgitation (AR) underwent aortic valve repair with (SP group, n = 14) or without (NSP group, n = 27) SP. SP was performed to reduce the circumference of the fused sinus and restore sinus contour symmetry. Preoperative and postoperative haemodynamic parameters were assessed at discharge and 1 year using transthoracic echocardiography. RESULTS: No deaths occurred within 1 year after surgery in either group. AR was well controlled and adequate left ventricular reverse remodelling was observed in both the groups up to 1 year postoperatively. At 1 year, lower transvalvular peak pressure gradient (PG) and maximum transvalvular flow velocity (Vmax) were observed in the SP group (peak PG: 17.7 ± 5.5 mmHg; % change -8.8% ± 1.1%, Vmax: 1.9 ± 0.31 m/s; % change -13.1% ± 2.1%) compared with the NSP group (peak PG: 24.7 ± 9.6 mmHg; +8.8% ± 1.3%, Vmax: 2.58 ± 0.62 m/s; +9.3% ± 2.5%), while there were no clear differences in % changes of peak PG or Vmax between the groups after adjustment for covariates. CONCLUSIONS: In BAV repair, SP was potentially associated with lower peak PG and Vmax at 1 year. These findings suggest that SP may enhance haemodynamic stability in BAV repair.

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Cite This Study

Maeda et al. (2026) conducted a cohort in Bicuspid aortic valve (BAV) with moderate-severe aortic regurgitation (n=41). Sinus plication vs. No sinus plication was evaluated on Transvalvular peak pressure gradient at 1 year (mmHg). Sinus plication during bicuspid aortic valve repair yielded lower unadjusted peak pressure gradients at 1 year (17.7 vs 24.7 mmHg), but differences were not significant after covariate adjustment.

synapsesocial.com/papers/69df2bece4eeef8a2a6b0e2a https://doi.org/10.1093/icvts/ivag103

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Haemodynamic early outcomes of sinus plication for bicuspid aortic valve repair

Figures

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Haemodynamic early outcomes of sinus plication for bicuspid aortic valve repair

Figures

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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