Aortic valve reconstruction with use of pericardial leaflets in adults with bicuspid aortic valve disease: early and midterm outcomes

• Published in: Texas Heart Institute journal 2014-12, Vol.41 (6), p.585-591
• Main Authors: Song, Meong Gun, Yang, Hyun Suk, Choi, Jong Bum, Shin, Je Kyoun, Chee, Hyun Keun, Kim, Jun Seok
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aortic Valve - abnormalities; Aortic Valve - physiopathology; Aortic Valve - surgery; Bicuspid Aortic Valve Disease; Bioprosthesis; Clinical Investigation; Disease-Free Survival; Echocardiography, Doppler, Color; Female; Heart Valve Diseases - diagnosis; Heart Valve Diseases - mortality; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Hemodynamics; Humans; Male; Middle Aged; Pericardium - surgery; Postoperative Complications - mortality; Postoperative Complications - surgery; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - mortality; Reoperation; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0730-2347; 1526-6702
• DOI: 10.14503/THIJ-13-3619

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm(2)/m(2). The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.