Repair of congenitally dysplastic aortic valve by bicuspidization: midterm results.

Abstract

Repair of congenital aortic valve (CAV) lesions may be achieved by creation of either tricuspid or bicuspid valve morphology. To define feasibility and outcome of CAV repair by bicuspidization a 10-year experience was reviewed. Between January 2002 and December 2011, 147 consecutive patients underwent operation for CAV insufficiency; 58 had valve or root repair (group 1) and 89 had valve or root replacement (group 2). Patients having repair were younger (42.9 vs 51.3 years, p=0.001), with lesser prevalence of severe insufficiency (72% vs 90%, p=0.002). In patients having repair, morphology of CAV was bicuspid in 51, monocuspid in 4, and quadricuspid in 3, whereas in the replacement group it was bicuspid in 87 and quadricuspid in 2 (p=0.04). Surgery consisted of an isolated aortic valve procedure in 20 versus 45 patients, associated with aortic root or ascending aortic repair in 38 versus 44 patients, in group 1 versus 2 (p=0.04). There were no hospital and 3 late deaths during a mean follow-up of 3.8±2.5 years (range 0.2 to 10.0). Eight-year survival (89%±10% vs 97%±2% [p=0.7]), freedom from valve-related events (84%±10% vs 89%±4% [p=0.8]), and freedom from aortic valve reoperation (95%±3% vs 93%±3% [p=0.6]) were comparable. Risk factors for reoperation at univariate analysis were isolated valve surgery (p=0.001), Ross operation (p=0.001), and endocarditis (p=0.002). Follow-up echocardiography of repair patients showed mild or less aortic insufficiency in 51 (88%) and mild or less stenosis in 57 (98%). Valve repair by preservation or creation of bicuspid morphology is feasible in almost half of all comers with CAV insufficiency, with satisfactory and stable midterm functional outcome. Rates of valve-related adverse events and reoperation are similar to those of patients having replacement.