Aortic root stability in bicuspid aortic valve disease: patch augmentation plus reduction aortoplasty versus modified David type repair☆

OBJECTIVES: The unreinforced aortic root, in bicuspid aortic valve disease, has been shown to dilate and cause recurrent regurgitation. The objective of this study was to determine whether reduction aortoplasty can reliably prevent aortic root dilatation after aortic valve repair in bicuspid disease. METHODS: A total of 66 patients, with a mean age of 41.2±12 years and with incompetent bicuspid aortic valves and concomitant dilatation of the aortic root, were included in this study. As many as 49 patients had patch augmentation of the free edge of the bicuspid aortic leaflets and reduction aortoplasty, and a further 17 patients had patch augmentation and a modified David type repair. Patients were followed up by echocardiography and clinically in yearly intervals. RESULTS: At midterm (mean follow-up was 5.1 ± 2.1 years), only one patient in the reduction aortoplasty group showed aortic root dilatation, leading to significant aortic valve regurgitation. Other than that, there was no progression of regurgitation in the whole group of patients. In the David type repair group, no re-operations, progression of aortic root dilatation or recurrent regurgitation occurred. In general, there was only one death in the reduction aortoplasty group. This patient developed endocarditis after 1 year and died of acute heart failure prior to readmission to our hospital. CONCLUSION: Both reduction aortoplasty and modified David type repair, paired with patch augmentation of the incompetent bicuspid valve, provide excellent midterm results. The reduction of the diameter of the ascending aorta by reduction aortoplasty seems to provide reliable stability that is comparable to the David type repair.