Key result
Simulation-guided symmetric bicuspidization shows no significant reduction in valve-related reoperations over historical controls.
Why the study?
Symmetric bicuspidization repair for outlet valve pathologies relies on subjective surgeon assessment, while computational work suggests optimal free-edge length sizing to 1.57 times aortic diameter.
Does simulation-guided standardized sizing of free-edge length improve outcomes and prevent valve-related reoperation in patients undergoing symmetric bicuspidization repair?
Cohort (n=14)
No
Does simulation-guided standardized sizing of free-edge length improve outcomes and prevent valve-related reoperation in patients undergoing symmetric bicuspidization repair?
Answers are grounded in this paper and cite their sources.
Applying computationally-derived sizing principles (free-edge length 1.57 times aortic diameter) in symmetric bicuspidization repair is feasible and may enhance early outcomes by reducing early valve-related reoperation and lowering gradient variability.
Background Symmetric bicuspidization repair for outlet valve pathologies relies on the surgeon's subjective assessment. Recent computational and ex-vivo work suggests sizing free-edge length to 1.57 times aortic diameter is optimal. This principle was applied clinically at our institution, and this study compares post-implementation outcomes with historical results. Methods All patients with attempted bicuspidization from 2011 to 2025 were queried. Primary outcome was freedom from valve-related reoperation or valve replacement. Secondary outcomes were cross-clamp time, number of bypass runs, mean transvalvular gradient, and regurgitation grade. Kaplan–Meier curves were generated for primary outcome with log-rank comparison. Secondary outcomes were compared with Wilcoxon rank-sum test. Results At median age 5.9 years, fourteen patients underwent symmetric bicuspidization (9 historical, 5 simulation-guided). Valve configuration included unicuspid ( n = 2), bicuspid ( n = 6), tricuspid ( n = 4), and quadricuspid ( n = 2). Repair indication was predominantly regurgitation ( n = 13/14, 93%). Five (56%) historical patients underwent reoperation compared with zero simulation-guided patients (median follow-up 948 vs. 455 days). Three (33%) historical patients required repeat bypass run, compared to zero simulation-guided. Cross-clamp time was not different between groups (72 vs. 89, p = 0.74). Acute and latest postoperative mean gradients were also not significantly different (acute: 13.5 vs. 9.6, p = 0.14; latest: 12.4 vs. 3.3, p = 0.08), though gradient variability was two to four times lower in the simulation-guided group. Conclusions This exploratory study presents promising early outcomes after prespecified, standardized sizing of the free-edge length in symmetric bicuspidization repair. Simulation-guided design can be applied in complex valve repair and may enhance early outcomes.
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Choi et al. (2026) conducted a cohort in Systemic outlet valve pathology requiring symmetric bicuspidization repair (n=14). Simulation-guided symmetric bicuspidization repair vs. Historical symmetric bicuspidization repair (surgeon's subjective assessment) was evaluated on Freedom from valve-related reoperation or valve replacement (p=0.09). Simulation-guided symmetric bicuspidization repair resulted in a 0% valve-related reoperation rate compared to 56% in historical subjective controls.
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