Bicuspidization and Annuloplasty Provide a Functioning Configuration to the Unicuspid Aortic Valve.

Abstract

This study reviewed a 12-year experience with a bicuspidization procedure that created a new commissure and added a patch for unicuspid aortic valve repair. All patients with a unicuspid aortic valve who underwent bicuspidization with autologous pericardium between 2003 and 2014 were evaluated. The new commissure had initially been created on the rudimentary anterior commissure, and since 2007, symmetric orientation was designed. Suture external annuloplasty was introduced after 2009 for basal ring dilatation. There were 137 consecutive patients. The median age at operation was 26 years (range, 3 to 64 years). Aortic regurgitation, aortic stenosis, and combined aortic regurgitation and stenosis were present in 68 (50%), 15 (11%), and 54 (39%) patients, respectively. A total of 71 patients were operated on after 2009. Annuloplasty was added in 47 patients. There were 2 early and 3 late deaths. Overall survival was 96% at 10 years. A total of 47 patients required aortic valve reoperation because of patch degeneration (n = 20), suture dehiscence of patch (n = 17), and other causes (n = 10). Freedom from aortic valve reoperation was 77% and 59% at 5 and 10 years, respectively, and 82% and 75% at 5 and 8 years in patients operated on after 2009, respectively. Suture dehiscence of the patch occurred significantly more often in patients with a basal ring diameter of 28 mm or larger before 2009 (38% in 5 years), and it decreased significantly with annuloplasty (9% in 5 years). Bicuspidization and annuloplasty create a functioning valve configuration in unicuspid aortic valve repair. Patch degeneration remains the main cause of reintervention and is the limiting factor for durability.