Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve : comparison with the 3-cusp David procedure
Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..
OBJECTIVE: Valve-sparing root reimplantation (VSRR) in tricuspid aortic valve (TAV) patients is well established, but in bicuspid aortic valve (BAV) patients, it has been less widely adopted. We assessed whether valve type affects midterm outcomes with VSRR.
METHODS: A retrospective review was performed of 186 patients who underwent an aortic valve-sparing root reimplantation operation between 2004 and 2013. Of these, 129 patients underwent elective VSRR with the David V technique. Outcomes were compared in this cohort by valve type: TAV (n = 89) versus BAV (n = 40).
RESULTS: Demographics were similar in the 2 groups. BAV patients had a higher degree of aortic insufficiency (AI) at presentation (P < .05), and an enlarged preoperative annulus (30 ± 4 vs 28 ± 6 mm, P = .06). All BAV patients required primary leaflet repair (6% in the TAV group; P < .01). Postoperative mortality (0), stroke (0% vs 1%), and pacemaker requirement (0% vs 5%) were similar. Postoperative freedom from AI grade ≥2+ was 100% in the entire cohort, and transvalvular gradients were similar. At follow-up, a 1-year echocardiogram showed higher peak and mean transvalvular gradients in the BAV group (P < .01). One TAV group patient died from an unknown cause. The 5-year actuarial freedom from aortic valve reoperation was 100% versus 97% ± 3% (P = .6). Three patients in the entire cohort have had AI grade >2+ on follow-up (n = 1 in the BAV group; n = 2 in the TAV group).
CONCLUSIONS: Even though BAV patients present with higher AI grade and require concomitant primary valve repair, the VSRR David V technique offers excellent midterm outcomes with both the BAV and TAV valve types.
| Errataetall: |
CommentIn: J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S28-9. - PMID 25500105 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:149 |
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| Enthalten in: |
The Journal of thoracic and cardiovascular surgery - 149(2015), 2 Suppl vom: 11. Feb., Seite S22-8 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bavaria, Joseph E [VerfasserIn] |
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| Anmerkungen: |
Date Completed 01.05.2015 Date Revised 08.04.2022 published: Print-Electronic CommentIn: J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S28-9. - PMID 25500105 Citation Status MEDLINE |
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| doi: |
10.1016/j.jtcvs.2014.10.103 |
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| 245 | 1 | 0 | |a Valve-sparing root reimplantation and leaflet repair in a bicuspid aortic valve |b comparison with the 3-cusp David procedure |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S28-9. - PMID 25500105 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: Valve-sparing root reimplantation (VSRR) in tricuspid aortic valve (TAV) patients is well established, but in bicuspid aortic valve (BAV) patients, it has been less widely adopted. We assessed whether valve type affects midterm outcomes with VSRR | ||
| 520 | |a METHODS: A retrospective review was performed of 186 patients who underwent an aortic valve-sparing root reimplantation operation between 2004 and 2013. Of these, 129 patients underwent elective VSRR with the David V technique. Outcomes were compared in this cohort by valve type: TAV (n = 89) versus BAV (n = 40) | ||
| 520 | |a RESULTS: Demographics were similar in the 2 groups. BAV patients had a higher degree of aortic insufficiency (AI) at presentation (P < .05), and an enlarged preoperative annulus (30 ± 4 vs 28 ± 6 mm, P = .06). All BAV patients required primary leaflet repair (6% in the TAV group; P < .01). Postoperative mortality (0), stroke (0% vs 1%), and pacemaker requirement (0% vs 5%) were similar. Postoperative freedom from AI grade ≥2+ was 100% in the entire cohort, and transvalvular gradients were similar. At follow-up, a 1-year echocardiogram showed higher peak and mean transvalvular gradients in the BAV group (P < .01). One TAV group patient died from an unknown cause. The 5-year actuarial freedom from aortic valve reoperation was 100% versus 97% ± 3% (P = .6). Three patients in the entire cohort have had AI grade >2+ on follow-up (n = 1 in the BAV group; n = 2 in the TAV group) | ||
| 520 | |a CONCLUSIONS: Even though BAV patients present with higher AI grade and require concomitant primary valve repair, the VSRR David V technique offers excellent midterm outcomes with both the BAV and TAV valve types | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Szeto, Wilson Y |e verfasserin |4 aut | |
| 700 | 1 | |a Komlo, Caroline |e verfasserin |4 aut | |
| 700 | 1 | |a Rhode, Tyler |e verfasserin |4 aut | |
| 700 | 1 | |a Wallen, Tyler |e verfasserin |4 aut | |
| 700 | 1 | |a Vallabhajosyula, Prashanth |e verfasserin |4 aut | |
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