Reconstructed Bicuspid Aortic Valve after 10 Years: Clinical and Echocardiographic Follow-up
DOI:
https://doi.org/10.1532/HSF98.20041066Abstract
Background: Sixteen patients (mean age, 30.9 ± 12.9 years; range, 9-79 years) with incompetent bicuspid aortic valves underwent valve-sparing correction between 1992 and 1995.
Methods: All patients underwent triangular resection of the enlarged leaflet. In addition, 13 patients underwent commissuroplasty. In 3 patients leaflet perforations were corrected with glutaraldehyde-fixed autologous pericardial patch. All patients underwent annual echocardiographic and clinical examinations at our institution.
Results: During follow-up 1 patient died of heart failure, and 3 patients underwent reoperations because of valve incompetence or dilatation of the sinus. Two patients underwent reoperation perioperatively. At long-term follow-up (mean, 10.06 ± 1.01 years) the remaining 10 patients were in New York Heart Association class I. No patient was receiving anticoagulation, and no thromboembolic, bleeding, or endocarditis events were observed in 107.2 cumulative patient-years of follow-up. Mean grade of regurgitation was 0.7 ± 0.5; mean aortic flow velocity was 2.29 ± 0.47 m/s. Optimal valvular function led to normal ventricular diameters (left ventricular end systolic diameter, 39.2 ± 4.3 mm; left ventricular end diastolic diameter, 56.2 ± 5.9 mm) and normal ventricular function (fractional shortening, 31.5% ± 0.1%). The dimensions of the aortic root were stable from 1-year to late followup (mean aortic annulus, 27.1 ± 6.8 mm; sinus of Valsalva, 33.0 ± 7.1 mm; sinotubular junction, 34.1 ± 7.7 mm; ascending aorta, 31.6 ± 7.4 mm). Conclusion: In contrast to early follow-up results of 5 reoperations, clinical and echocardiographic results were excellent for 10 patients who had undergone reconstruction of bicuspid incompetent aortic valves, and the patients were in stable condition after 10 years. However, the mode of early failure is unknown. Reconstruction of bicuspid valves is possible in selected patients.
References
Fraser CD, Wang N, Mee RB, et al. 1994. Repair of insufficient bicuspid aortic valves. Ann Thorac Surg 58:386-90.nGrabenwoeger M, Sider J, Fitzal F, et al. 1996. Impact of glutaraldehyde on calcification of pericardial bioprosthetic heart valve material. Ann Thorac Surg 62:772-7.nHahn RT, Roman MJ, Mogtader AH, Devereux RB. 1992. Association of aortic root dilation with regurgitation, stenotic and functionally normal bicuspid aortic valves. J Am Coll Cardiol 19:283-8.nHoffmann JI, Kaplan S. 2002. The incidence of congenital heart disease. J Am Coll Cardiol 39:1890-900.nJamieson WR, Rosado LJ, Munro AI et al. 1988. Carpentier-Edwards standard porcine bioprosthesis: primary tissue failure (structural valve degeneration) by age groups. Ann Thorac Surg 46:155-62.nKunzelman KS, Grande KJ, David TE, Cochran RP, Verrier ED. 1994. Aortic root and valve relationships: impact on surgical repair. Thorac Cardiovasc Surg 107:162-70.nMcGiffin DC, Galbraith AJ, O'Brien M F et al. 1997. An analysis of valve re-replacement after aortic valve replacement with biologic devices. J Thorac Cardiovasc Surg 113:311-8.nSchafers HJ, Langer F, Aicher D, Graeter TP, Wendler O. 2000. Remodeling of the aortic root and reconstruction of the bicuspid aortic valve. Ann Thorac Surg 70:542-6.nThrubrikar M. 1990. Diseases of the aortic valve. In: The Aortic Valve. Boca Raton, FL: CRC Press; 157-74.nWard C. 2000. Clinical significance of the bicuspid aortic valve. Heart 83:81-5.nWestaby S, Karp RB, Blackstone EH, Bishop SP. 1984. Adult human valve dimensions and their surgical significance. Am J Cardiol 53:552-6.nWeyman AE. 1994. Principles and Practice of Echocardiography. 2nd ed. Philadelphia: PA: Lea and Febiger: 1289-98.nBrewer RJ, Deck JD, Capati B, Nolan SP. 1976. The dynamic aortic root: its role in aortic valve function. J Thorac Cardiovasc Surg 72:413-7.nCannegieter SC, Rosendaal FR, Briet E. 1994. Thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis. Circulation 89:635-41.nCarr JA, Savage EB. 2004. Aortic valve repair for aortic insufficiency in adults: a contemporary review and comparison with replacement tecniques. Eur J Cardiothorac Surg 25:6-15.nCasselman FP, Gillinov AM, Akhrass R, Blackstone EH, Cosgrove DM.n1999. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg 15:302-8.nClarke DR, Campell DN, Hayward AR, Bishop DA. 1993. Degeneration of aortic valve allografts in young recipients. J Thorac Cardiovasc Surg 105:934-42.nDavierwala PM, David TE, Armstrong S, Ivanov J. 2003. Aortic valve repair versus replacement in bicuspid aortic valve disease. J Heart Valve Dis 12:679-86.nde Sa M, Moshkovitz Y, Butany J, David TE. 1999. Histologic abnoRmalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the Ross procedure. J Thorac Cardiovasc Surg 118:588-94.nFerencik M, Pape LA. 2003. Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves. Am J Cardiol 92:43-6.nMcKusick VA. 1972. Association of congenital bicuspid aortic valve and Erdheim's cystic medial necrosis. Lancet 1:1026-7.nMercer JL, Benedicty M, Bahnson HT. 1973. The geometry and construction of the aortic leaflet. J Thorac Cardiovasc Surg 65:511-8.nMills P, Leech G, Davies M, Leatham A. 1978. The natural history of a non-stenotic bicuspid aortic valve. Br Heart J 40:951-7.nMoidl R, Moritz A, Simon P, Kupilik N, Wolner E, Mohl W. 1995. Echocardiographic results after repair of incompetent bicuspid aortic valves. Ann Thorac Surg 60:669-72.nPachulski RT, Weinberg AL, Chan KL. 1991. Aortic aneurysm in patients with functionally normal or minimally stenotic bicuspid aortic valve. Am J Cardiol 67:781-2.nRao V, Van Arsdell GS, David TE, Azakie A, Williams WG. 2000. Aortic valve repair for adult congenital heart disease. Circulation 102:III40-3.nRoberts WC. 1970. The congenitally bicuspid aortic valve: a study of 85 autopsy cases. Am J Cardiol 26:72-83.n
