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Geometric orientation of the aortic neoroot in patients with raphed bicuspid aortic valve disease undergoing primary cusp repair and a root reimplantation procedure

Geometric orientation of the aortic neoroot in patients with raphed bicuspid aortic valve disease... OBJECTIVESPrimary cusp repair aortic root reimplantation in bicuspid aortic valve (BAV) disease presenting with root aneurysm with aortic insufficiency (AI) is an effective surgical treatment. We assessed whether the geometric orientation of the repaired BAV into its reimplanted neoroot affects outcomes180/180 orientation was compared with the 150/210 orientation.METHODSFrom 2005 to 2012, 66 BAV repairs were performed. This is a retrospective review of all types of Ib/II BAV AI patients undergoing root reimplantation (n 26) at two different geometric orientations: 180/180 (n 11) vs 150/210 (n 15). In the 180/180 group, reimplantation into the neoroot was such that both conjoint and non-conjoint cusps occupied 180 of the annular circumference. In the 150/210 group, the repaired valve was configured to the more typical native orientation of a type I BAV: the non-conjoint cusp occupied 150, and the conjoint cusp occupied 210 of the annular circumference.RESULTSPreoperative characteristics were similar in both groups. In-hospital mortality, stroke, reoperation, renal failure and pacemaker rates were zero in both groups. No patient left the operating room with >1 AI and one had a peak gradient >20 mmHg. Transvalvular gradients were higher in the 180/180 group, but not significant (P > 0.05). M.ean follow-ups for the 180/180 and 150/210 group were 48 and 33 months, respectively. Actuarial freedom from AI >2 at 5 years was 100 in both groups. Freedom from AI >1 at 5 years was 90 10 in the 150/210 group and 86 13 in the 180/180 group (P 0.71). Freedom from peak gradient >20 mmHg was 80 (n 8) in the 180/180 group and 100 in the 150/210 group at 1-year follow-up. Transvalvular gradients were higher in the 180/180 group (16 8 vs 10 4 mmHg, P 0.02; 9 3 vs 5 3 mmHg, P 0.01). Five-year actuarial survival and freedom from aortic reoperation have remained at 100 in the entire cohort.CONCLUSIONCusp repair root reimplantation for BAV type Ib/II AI can be safely performed at either geometric orientation. Conceptually, 150/210 orientation respects the natural type I BAV anatomy with regard to cusp surface area and leaflet insertion perimeter. The 180/180 group may have higher transvalvular gradients and smaller coaptation zones than the 150/210 group. Further follow-up may reveal the superiority of one geometric orientation over the other. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Geometric orientation of the aortic neoroot in patients with raphed bicuspid aortic valve disease undergoing primary cusp repair and a root reimplantation procedure

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References (24)

Publisher
Oxford University Press
Copyright
The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Subject
AORTIC SURGERY
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1093/ejcts/ezt354
pmid
23832833
Publisher site
See Article on Publisher Site

Abstract

OBJECTIVESPrimary cusp repair aortic root reimplantation in bicuspid aortic valve (BAV) disease presenting with root aneurysm with aortic insufficiency (AI) is an effective surgical treatment. We assessed whether the geometric orientation of the repaired BAV into its reimplanted neoroot affects outcomes180/180 orientation was compared with the 150/210 orientation.METHODSFrom 2005 to 2012, 66 BAV repairs were performed. This is a retrospective review of all types of Ib/II BAV AI patients undergoing root reimplantation (n 26) at two different geometric orientations: 180/180 (n 11) vs 150/210 (n 15). In the 180/180 group, reimplantation into the neoroot was such that both conjoint and non-conjoint cusps occupied 180 of the annular circumference. In the 150/210 group, the repaired valve was configured to the more typical native orientation of a type I BAV: the non-conjoint cusp occupied 150, and the conjoint cusp occupied 210 of the annular circumference.RESULTSPreoperative characteristics were similar in both groups. In-hospital mortality, stroke, reoperation, renal failure and pacemaker rates were zero in both groups. No patient left the operating room with >1 AI and one had a peak gradient >20 mmHg. Transvalvular gradients were higher in the 180/180 group, but not significant (P > 0.05). M.ean follow-ups for the 180/180 and 150/210 group were 48 and 33 months, respectively. Actuarial freedom from AI >2 at 5 years was 100 in both groups. Freedom from AI >1 at 5 years was 90 10 in the 150/210 group and 86 13 in the 180/180 group (P 0.71). Freedom from peak gradient >20 mmHg was 80 (n 8) in the 180/180 group and 100 in the 150/210 group at 1-year follow-up. Transvalvular gradients were higher in the 180/180 group (16 8 vs 10 4 mmHg, P 0.02; 9 3 vs 5 3 mmHg, P 0.01). Five-year actuarial survival and freedom from aortic reoperation have remained at 100 in the entire cohort.CONCLUSIONCusp repair root reimplantation for BAV type Ib/II AI can be safely performed at either geometric orientation. Conceptually, 150/210 orientation respects the natural type I BAV anatomy with regard to cusp surface area and leaflet insertion perimeter. The 180/180 group may have higher transvalvular gradients and smaller coaptation zones than the 150/210 group. Further follow-up may reveal the superiority of one geometric orientation over the other.

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Jan 5, 2014

Keywords: Bicuspid aortic valve Root reimplantation Aortic valve repair

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