Reconstructed Bicuspid Aortic Valve after 10 Years: Clinical and Echocardiographic Follow-up

BACKGROUND: Sixteen patients (mean age, 30.9 +/- 12.9 years; range, 9-79 years) with incompetent bicuspid aortic valves underwent valve-sparing correction between 1992 and 1995. METHODS: All patients underwent triangular resection of the enlarged leaflet. In addition, 13 patients underwent commissuroplasty. In 3 patients leaflet perforations were corrected with glutaraldehyde-fixed autologous pericardial patch. All patients underwent annual echocardiographic and clinical examinations at our institution. RESULTS: During follow-up 1 patient died of heart failure, and 3 patients underwent reoperations because of valve incompetence or dilatation of the sinus. Two patients underwent reoperation perioperatively. At long-term follow-up (mean, 10.06 +/- 1.01 years) the remaining 10 patients were in New York Heart Association class I. No patient was receiving anticoagulation, and no thromboembolic, bleeding, or endocarditis events were observed in 107.2 cumulative patientyears of follow-up. Mean grade of regurgitation was 0.7 +/- 0.5; mean aortic flow velocity was 2.29 +/- 0.47 m/s. Optimal valvular function led to normal ventricular diameters (left ventricular end systolic diameter, 39.2 +/- 4.3 mm; left ventricular end diastolic diameter, 56.2 +/- 5.9 mm) and normal ventricular function (fractional shortening, 31.5% +/- 0.1%). The dimensions of the aortic root were stable from 1-year to late followup (mean aortic annulus, 27.1 +/- 6.8 mm; sinus of Valsalva, 33.0 +/- 7.1 mm; sinotubular junction, 34.1 +/- 7.7 mm; ascending aorta, 31.6 +/- 7.4 mm). CONCLUSION: In contrast to early follow-up results of 5 reoperations, clinical and echocardiographic results were excellent for 10 patients who had undergone reconstruction of bicuspid incompetent aortic valves, and the patients were in stable condition after 10 years. However, the mode of early failure is unknown. Reconstruction of bicuspid valves is possible in selected patients.