Long terms results after bicuspid aortic valve repair according to functional classification of aortic

insufficiency

Khalil Fattouch, Giacomo Murana, Sebastiano Castrovinci, Massimo Salardino, Antonio Rubino, Emanuela Clara Bertolino, Giuseppa Caccamo, Roberta Sampognaro, Patrizio

Lancellotti, Giovanni Ruvolo

-- From February 2003, 66 patients were referred to our institutions for elective AVR repair for regurgitant bicuspid aortic valve

-- Clinical and Echocardiographic follow-up was 100% complete.

-- Mean follow-up: 40±16 months [range 3 – 82 months]

Patients and Methods

Patients characteristics

Variables

patients (%)

Age (years)

Male gender

Diabetes

COPD

Hypertension

Creatinine > 1.5 mg/dl

Angina

Atrial fibrillation

53±15

50 (75.7%)

6 (9%)

6 (9%)

30 (45%)

3 (4.5%)

2 (3%)

4 (6%)

Variables

patients (%)

NYHA Class

II

III

IV

41 (62.1%)

20 (30.3%)

5 (7.6%)

Logistic EuroSCORE

5.2±3.1

BAV insufficiency according to Functional classification

Type I:

Normal leaflet motion

Type II:

Excessive leaflets motion

Type III:

Restrictive leaflets motion

16 patients (24.2%)

40 patients (60.6%)

10 patients (15%)

Intraoperative Data and Surgical Techniques

Variables N° of patients (%) Cusp repair :

Plication

Free edge reinforcement

Chordae technique

Triangular resection

Pericardial patch

30 (45.4%)

25 (37.8%)

25 (37.8%) 

10 (15.1%)

8 (12.2)

Surgery of root dilatation:

Valve reimplantation

Supracommissural aortic replacement

Sub-commissural plasty

41 (62.1%)

25 (37.9%)

18 (27.2%)

Early Results

• In-hospital deaths was 1.5 %• Re-exploration for bleeding was needed in 3

(4.5%) patients• The mean postoperative hospital stay was 9±2

days

Late Outcomes

(%)

1 2 3 4 5 6years

Overall late survival 90.9 %

Late Outcomes

Freedom from recurrence of AR ≥ grade II was 92.5%

(%)

1 2 3 4 5 6

years

Type I

Type II

Type III

Per

cent

age

of S

urvi

val (

%)

years

Freedom from valve-related events according to functional classification

p<0.001

Late Outcomes

Late Outcomes

Freedom from valve related-events between the different surgical approach

PlicationThe chordae techniqueFree edge reinforcement

p<0.01

1 2 3 4 5 6

years

(%)

Late Outcomes

Freedom from valve related-events according to type of ascending aorta or root surgery

p=0.02

AVR+ root reimplantationAVR+ ascending aorta replacementAVR

1 2 3 4 5 6

(%)

years

Conclusions

In our experience, BAV can be reproducibly reconstructed with good long term results.

Patients with bicuspid valve and severely calcified raphe have poor outcomes.

Plication or “the chordae technique” improve long term results compared to free edge reinforcement.

Root replacement had better outcomes compared with isolated AVR.