Key result
Sievers' S1 bicuspid aortic valve type was associated with a higher rate of mild aortic regurgitation progression at 4 years compared to SØ type (76% vs 32%, P=0.017) after valve-sparing surgery.
Why the study?
Does Sievers' BAV type or commissural angular configuration impact mid-term valve performance after Tirone David-V valve-sparing aortic root replacement in patients with bicuspid aortic valve disease?
Cohort (n=85)
Does Sievers' BAV type or commissural angular configuration impact mid-term valve performance after Tirone David-V valve-sparing aortic root replacement in patients with bicuspid aortic valve disease?
Answers are grounded in this paper and cite their sources.
Sievers' BAV type (SØ superior to S1), rather than commissure geometry within the neoroot alone, is linked to functional outcomes and AR progression after valve-sparing aortic root replacement.
OBJECTIVES: A 180/180° configuration has been reported to increase repair durability after valve-sparing aortic root replacement (V-SARR) for bicuspid aortic valve (BAV) disease. We studied the impact of commissural angular configuration (CAC) and of BAV type on valve performance after V-SARR. METHODS: A total of 85 BAV patients (68 males, age 44 ± 11 years) underwent Tirone David-V V-SARR between 1997 and 2013. BAV type was documented intraoperatively, and CAC determined from pre- and postoperative computed tomography scans as the angle subtended by the non-fused cusp. Transthoracic echocardiogram was performed at 6 ± 3 days and at 2.9 ± 2.1 years. Functional end-points included freedom from aortic regurgitation (AR) 1+, AR 2+ and freedom from AR progression (0 to 1+, or 1+ to 2+). Tested variables included preoperative CAC (>160 vs <160°) and changes in CAC after V-SARR (Δ > 30° vs Δ < 30°) and Sievers' BAV type (SØ or S1). RESULTS: CAC in SØ-BAV (n = 26) changed minimally from 164 ± 12 to 171 ± 11° (mean Δ = 7.2 ± 16°, P = 0.044), whereas in S1-BAV (n = 59) CAC changed substantially from 132 ± 19 to 156 ± 18° (mean Δ = 27 ± 21°, P < 0.001). Larger postoperative CAC angles were not linked to better mid-term valve performance, but Sievers' BAV type had a major effect on valve performance: mild AR in S1/i BAV progressed more often (76 vs 32% at 4 years, P = 0.017) and 1+ AR was more frequent (70 vs 36% at 4 years, P = 0.008) compared with SØ-BAV. CONCLUSIONS: BAV type, including number of raphes, sinuses and commissures (SØ superior to S1) but not commissure geometry within the neoroot alone, appears to be linked to functional outcomes after V-SARR for BAV.
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Kari et al. (2014) conducted a cohort in Bicuspid aortic valve (BAV) disease (n=85). Sievers' S1 bicuspid aortic valve type vs. Sievers' SØ bicuspid aortic valve type was evaluated on Mild aortic regurgitation progression at 4 years (p=0.017). Sievers' S1 bicuspid aortic valve type was associated with a higher rate of mild aortic regurgitation progression at 4 years compared to SØ type (76% vs 32%, P=0.017) after valve-sparing surgery.
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