Why the study?
Does aortic valve repair guided by morphology and function assessment prevent recurrent aortic insufficiency and reintervention in patients with bicuspid aortic valve?
Cohort (n=152)
Does aortic valve repair guided by morphology and function assessment prevent recurrent aortic insufficiency and reintervention in patients with bicuspid aortic valve?
Bicuspid aortic valve repair guided by morphology and function assessment yields low rates of recurrent aortic insufficiency, particularly when combined with annulus stabilization.
Answers are grounded in this paper and cite their sources.
Reimplantation may reduce reintervention risk after bicuspid aortic valve repair; leaves open need for randomized confirmation.
OBJECTIVES: Bicuspid aortic valve (BAV) is frequently associated with aortic insufficiency (AI) due to cusp disease and/or aortic root dilatation. Based on functional classification and morphology, a systematic surgical approach was used for aortic valve repair (AVr). METHODS: From 2004 to 2014, 152 consecutive patients (mean age 55 ± 7 years) with BAV underwent AVr with or without concomitant aortic root surgery. Cusp pathology was treated with central plication in 60 (39.5%) patients, free edge reinforcement in 45 (29.6%), triangular resection in 28 (18.4%) and pericardial patch in 19 (12.5%). Aortic root dilatation was corrected with valve sparing reimplantation in 65 patients. Mean follow-up was 68 ± 36 months. RESULTS: In-hospital death was 1.3%. Overall 5-year survival was 88.6 ± 3.6%. Freedom from recurrent ≥ grade 2 AI requiring reoperation at 5-year was 93 ± 3.1%. Five-year freedom from reintervention was 98.4 ± 1.6%, 93.3 ± 6.4% and 82.6 ± 9.6 in the group of patients treated with AVr and reimplantation technique, AVr and subcommissural plasty and AVr repair alone (log-rank P = 0.005). Commissural orientation <160°, type 2 Siever's BAV and preoperative annulus diameter >29 mm were identified as predictors for recurrent ≥ grade 2 AI. CONCLUSIONS: BAV repair could be achieved with low incidence of recurrent AI, especially when concomitant annulus stabilization was performed. Systematic preoperative morphological and functional characteristics of the aortic valve should be carried out in order to reduce the risk of repair failure.
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Fattouch et al. (2017) conducted a cohort in Bicuspid aortic valve with aortic insufficiency (n=152). Aortic valve repair with reimplantation technique vs. Aortic valve repair alone or with subcommissural plasty was evaluated on 5-year freedom from reintervention (p=0.005).
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