Reconstruction of the bicuspid aortic valve yielded 81% freedom from reoperation at 10 years, with use of a pericardial patch strongly predicting reoperation (HR 5.16).
Cohort (n=316)
What are the predictors of reoperation after reconstruction of a regurgitant bicuspid aortic valve?
Reconstruction of bicuspid aortic valves yields good early results, but long-term freedom from reoperation is heavily dependent on anatomic features and repair techniques, particularly the use of a pericardial patch.
Hazard Ratio: 5.16
BACKGROUND: Reconstruction of the regurgitant bicuspid aortic valve has been performed for >10 years, but there is limited information on long-term results. We analyzed our results to determine the predictors of suboptimal outcome. METHODS AND RESULTS: Between November 1995 and December 2008, 316 patients (age, 49±14 years; male, 268) underwent reconstruction of a regurgitant bicuspid aortic valve. Intraoperative assessment included extent of fusion, root dimensions, circumferential orientation of the 2 normal commissures (>160°, ≤160°), and effective height after repair. Cusp pathology was treated by central plication (n=277), triangular resection (n=138), or pericardial patch (n=94). Root dilatation was treated by subcommissural plication (n=100), root remodeling (n=122), or valve reimplantation (n=2). All patients were followed up echocardiographically (cumulative follow-up, 1253 years; mean, 4±3.1 years). Clinical and morphological parameters were analyzed for correlation with 10-year freedom from reoperation with the Cox proportional hazards model. Hospital mortality was 0.63%; survival was 92% at 10 years. Freedom from reoperation at 5 and 10 years was 88% and 81%; freedom from valve replacement, 95% and 84%. By univariable analysis, statistically significant predictors of reoperation were age (hazard ratio HR=0.97), aortoventricular diameter (HR=1.24), effective height (HR=0.76), commissural orientation (HR=0.95), use of a pericardial patch (HR=7.63), no root replacement (HR=3.80), subcommissural plication (HR=2.07), and preoperative aortic regurgitation grade 3 or greater. By multivariable analysis, statistically significant predictors for reoperation were age (HR=0.96), aortoventricular diameter (HR=1.30), effective height (HR=0.74), commissural orientation (HR=0.96), and use of a pericardial patch (HR=5.16). CONCLUSIONS: Reconstruction of bicuspid aortic valve can be performed reproducibly with good early results. Recurrence and progression of regurgitation, however, may occur, depending primarily on anatomic features of the valve.
Aicher et al. (2011) conducted a cohort in Regurgitant bicuspid aortic valve (n=316). Use of a pericardial patch (and other anatomic/procedural factors) was evaluated on 10-year freedom from reoperation (HR 5.16). Reconstruction of the bicuspid aortic valve yielded 81% freedom from reoperation at 10 years, with use of a pericardial patch strongly predicting reoperation (HR 5.16).