Key result
Preservation of healthy-appearing bicuspid aortic valves during ascending aortic aneurysm surgery led to severe stenosis or regurgitation in 8.7% of patients over an average 4.5-year follow-up.
Why the study?
The fate of the spared bicuspid aortic valve in patients undergoing ascending aortic aneurysm surgery was relatively unknown.
Does preservation of healthy-appearing bicuspid aortic valves during ascending aortic aneurysmectomy result in stable long-term valve function?
Cohort (n=23)
No
Does preservation of healthy-appearing bicuspid aortic valves during ascending aortic aneurysmectomy result in stable long-term valve function?
Bicuspid aortic valves that are free of significant stenosis or regurgitation and appear healthy can be safely preserved during ascending aortic aneurysm surgery with a low rate of subsequent reoperation.
May support selective preservation with surveillance; leaves open long-term durability versus replacement in bicuspid aortopathy.
BACKGROUND: The fate of the spared bicuspid aortic valve in patients undergoing ascending aortic aneurysm surgery is relatively unknown. Our institutional policy has been to replace all aortic valves with significant abnormalities, as evidenced by intraoperative transesophageal echocardiography or direct visual inspection. In this study, we elaborate our experience regarding the long-term fate of preserved bicuspid aortic valves after ascending aortic aneurysm extirpation. MATERIALS AND METHODS: From 2000 to 2018, 407 consecutive ascending aortic aneurysm patients with concomitant bicuspid aortic valves underwent surgery by a single surgeon at our institution. Among these, 23 (5.65%) patients did not have their valve replaced, forming the study group. Postoperative and preoperative echocardiograms were compared to determine changes in valve function. RESULTS: Follow-up was complete in 100% of patients. The average time between preoperative and postoperative echocardiograms was 4.50 ± 4.09 years (0.19-15.63). Aortic stenosis or regurgitation changed from none to mild in 5 (21.7%) of patients, with an average echocardiographic interval follow-up of 3.08 years, and from none to severe in 2 (8.7%), with an interval of 11.7 years. One patient required reoperation, including aortic valve replacement, during follow-up. CONCLUSION: Bicuspid aortic valves free of aortic stenosis or insufficiency before surgery and "healthy" appearing at surgery can safely be preserved.
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Vinholo et al. (2019) conducted a cohort in Ascending aortic aneurysm with concomitant bicuspid aortic valves (n=23). Preservation of bicuspid aortic valve was evaluated on Changes in valve function (aortic stenosis or regurgitation). Preservation of healthy-appearing bicuspid aortic valves during ascending aortic aneurysm surgery led to severe stenosis or regurgitation in 8.7% of patients over an average 4.5-year follow-up.
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