Key result
Valve-sparing root replacement in bicuspid aortic valves achieves ~93% overall survival at ten years.
Why the study?
Reported outcomes in patients with bicuspid aortic valves undergoing valve-sparing aortic root replacement are scarce.
Does valve-sparing aortic root replacement using the reimplantation technique provide durable survival and freedom from reintervention in adult patients with bicuspid aortic valves and aortic root aneurysm or insufficiency?
Cohort (n=498)
Yes
Does valve-sparing aortic root replacement using the reimplantation technique provide durable survival and freedom from reintervention in adult patients with bicuspid aortic valves and aortic root aneurysm or insufficiency?
The reimplantation (David) technique for valve-sparing aortic root replacement in patients with bicuspid aortic valves demonstrates excellent 10-year survival and freedom from reintervention, particularly when performed in experienced centers.
Supports reimplantation in experienced centers for bicuspid valves; leaves open need for randomized comparisons to replacement.
OBJECTIVE: Reported outcomes in patients with bicuspid aortic valves (BAVs) undergoing valve-sparing aortic root replacement (VSRR) are scarce. This study aims to evaluate outcomes in patients with BAV using the reimplantation (David) technique. METHODS: Consecutive adult patients with BAV, aortic root aneurysm, and/or aortic valve insufficiency (AI) undergoing VSRR (reimplantation) were included from 5 centers experienced in reimplantation procedures. Patients were subcategorized into 2 groups with different primary indications for operation: (1) aneurysm, and (2) isolated AI. Exclusion criteria included acute aortic dissection, endocarditis, and valvular-stenosis. RESULTS: In total, 498 patients were included. Mean age was 45.4 years (±11.8 years); median follow-up was 5.4 years (interquartile range, 2.3-8.7 years). Group 1 included aneurysm (n = 144) and group 2 included AI (n = 354). There was 1 in-hospital death. Survival (overall) was 93.4% (95% confidence interval [CI], 92-97%) at 10 years, with no difference between groups (P = .93) observed. Freedom from reintervention at 1 year was 99.1% (95% CI, 99%-100%), at 5 years 95.4% (95% CI, 93%-97%), and at 10 years 89.2% (95% CI, 86%-93%) for patients with aneurysm 100% at 1 year and 95.4% (95% CI, 92%-98%) at 10 years; and for AI 98.9% (95% CI, 98%-99%) at 1 year and 86.4% (95% CI, 83%-91%) at 10 years. Cusp fenestrations (P = .01), prolapse (P = .04), and isolated AI (0.03) were associated with greater hazard of reintervention. CONCLUSIONS: This multicenter study shows excellent results after VSRR reimplantation procedure in patients with BAV and aortic aneurysm and/or valve insufficiency. Isolated AI and cusp abnormalities are associated with greater reintervention rates and may reflect more advanced leaflet disease. The reimplantation technique, when performed in expert centers, appears to be an excellent treatment strategy in BAV.
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Arabkhani et al. (2025) conducted a cohort in Bicuspid aortic valve (BAV) with aortic root aneurysm and/or aortic valve insufficiency (AI) (n=498). Valve-sparing aortic root replacement (VSRR) using the reimplantation (David) technique was evaluated on Overall survival at 10 years (95% CI 92-97). Valve-sparing aortic root replacement using the reimplantation technique in patients with bicuspid aortic valves achieved an overall 10-year survival of 93.4% and 10-year freedom from reintervention of 89.2%.
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