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Isolated Bicuspid Aortic Valve Repair in the Current Era - Annuloplasty Leads to Improved Mid-term Stability
Ulrich Schneider, MD, Irem Karliova, MD, Christian Giebels, MD, Tristan Ehrlich, MD, Hans-Joachim Schäfers, MD.
Saarland University Medical Center, Homburg, Germany.

OBJECTIVE: Isolated repair of the bicuspid aortic valve (BAV) has been drastically improved by the addition of a suture annuloplasty (SA) for correction of annular dilatation. We have analyzed the mid-term results using the current approach.
METHODS: A total of 341 patients (mean age 41±15 years, 317 male) underwent isolated BAV repair for severe aortic regurgitation (AR) from January 2009 to October 2018 (study group). Patients who had undergone isolated BAV repair prior to 2009 (n=105) served as controls. In the study group, SA was applied whenever the diameter of the basal ring exceeded 26 to 27mm (n=311, 91.2%). Initially, a polyester suture was used (n=38), subsequently polytetrafluorethylene (PTFE, n=273). In the control group, subcommissural plication was used as annulolplasty (n=59). Differences between the groups occurred regarding the extent of fusion and the techniques for cusp repair.
RESULTS: Basal size was larger in the study group (p<0.001), age was lower (p=0.013). Nine-year survival was 100% in the study group and 88.2% in the controls (p<0.001). Reoperation on the aortic valve was necessary in 10 patients of the study group and 38 of the controls leading to a 9-year freedom from reoperation of 94.6% and 67.4% (study vs. controls, p<0.001). Complications caused by SA led to reoperation in another 6 patients (2.5%). Occlusion of the circumflex artery required early reintervention and removal of SA in 4 patients (1.7%, polyester: n=2, PTFE: n=2). In 2 patients (0.8%), closure of ventricular septal defect was performed due to erosion of the membranous septum (only after polyester SA). Freedom from recurrent AR≥II at 9 years was significantly improved from 62.9% in the control group to 86.4% in the study group (p<0.001).
CONCLUSIONS: Isolated BAV repair with correction of basal dilatation by SA leads to excellent mid-term stability and a low incidence of SA related complications.


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