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Symmetric Bicuspidization and Annuloplasty Provide a Functioning Valve Configuration to Unicuspid Aortic Valve
Shunsuke Matsushima, MD, Takashi Igarashi, MD, PhD, Atsushi Shimizu, MD, Tristan Ehrlich, MD, Irem Karliova, MD, Hans-Joachim Schäfers, MD, PhD.
Saarland University Medical Center, Homburg/Saar, Germany.

OBJECTIVE: Durable repair of a unicuspid aortic valve (UAV) is challenging. We have proposed bicuspidization by creating a new commissure and adding patch material. The present study reviews our 12-year experience with this procedure.
METHODS: All patients with UAV 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 commissural orientation was designed. Suture external annuloplasty was introduced after 2009 in patients with annular dilation.
RESULTS: There were 136 consecutive patients. The median age at operation was 26 [3-64] years. Aortic regurgitation, aortic stenosis, and combined aortic regurgitation and stenosis were present in 68 (50%), 14 (10%), and 54 (40%) patients, respectively. Seventy-one (52%) patients were operated after 2009, and annuloplasty was added in 47. There were 2 early and 3 late deaths. Overall survival was 96% at 10 years. Forty-five patients required aortic valve reoperation due to patch degeneration (n=19), suture dehiscence of patch (n=17), and others (n=9). Freedom from aortic valve reoperation was 78% and 62% at 5 and 10 years, respectively, and 82% at 5 years in patients operated after 2009. Suture dehiscence of patch occurred significantly in patients with the aortoventricular junction ≥ 28mm before 2009 (38% in 5 years), and decreased significantly with annuloplasty (9% in 5 years).
CONCLUSIONS: With symmetric bicuspidization und annuloplasty, a functioning valve configuration can be created in UAV. Patch degeneration remains the main cause for reintervention and is thus the limitation for durability.


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