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Geometrical Correlation Between The Right And Left Ventricular Outflow Tract In Young Bav Vs. Tav Patients: Implications For The Ross Procedure
Shiho Naito, Hermann Reichenspurner, Evaldas Girdauskas.
University Heart Center Hamburg, Hamburg, Germany.

OBJECTIVE: Ross procedure has been recommended as an excellent strategy for the treatment of stenotic aortic valve lesions in young patients’ population. However, there are still concerns when implementing pulmonary autograft in patients with bicuspid aortic valve (BAV). Therefore, we aim to analyze the geometric discrepancies between right and left ventricular outflow tract in young patients with BAV vs. tricuspid aortic valve (TAV) using multi-detected computed tomography (MDCT).
METHODS: A total of consecutive 43 patients between 20 and 70 years old who were referred for aortic valve operation and underwent preoperative MDCT between January 2016 and June 2018, were retrospectively analyzed. Patients with aortic root /ascending aortic aneurysm or annuloaortic ectasia were excluded. Based on preoperative transesophageal echocardiography, a total of 35 patients were diagnosed with BAV, whereas the remaining 8 patients had TAV. Using MDCT, the diameter of aortic valve (AV) annulus and pulmonary valve (PV) annulus, left and right ventricular outflow tract were measured and compared in BAV vs. TAV patients.
RESULTS: There was a tendency towards larger LVOT and aortic root diameters in BAV cohort (Table 1). Contrary to that, RVOT and pulmonary artery diameters were comparable between BAV and TAV patients. We found no relevant discrepancy between LVOT/RVOT in BAV vs. TAV patients. Furthermore, there was no significant difference between AV orifice area vs. PV orifice area in BAV vs. TAV patients.
CONCLUSIONS: Our study revealed no significant geometrical discrepancies between left and right outflow tracts in young BAV patients as compared to the TAV patients. Therefore, geometric discrepancies between pulmonary autograft and aortic root should not be used as an argument to abandon Ross procedure in young BAV patients.

Table 1.
BAV(n=35)TAV(n=8)p-value
LVOT/ Sinus Valsalva/ Ascending aorta (mm)27.0±4.5/ 39.2±4.1/ 38.4±7.224.2±3.0/ 33.4±6.1/ 34.0±5.10.130/ 0.045/0.022
AV Annulus min/max (mm)28.2±2.9/ 33.7±3.326.8±2.6/ 31.9±5.00.289/ 0.242
Aortic valve area (cm2)7.5±1.57.0±1.90.249
RVOT/ Pulmonary artery (mm)26.0±5.6/ 26.2±3.326.2±6.0/ 26.0±2.00.742/ 0.522
PV Annulus min/ max (mm)27.4±3.5/ 35.3±3.527.8±2.6/ 35.1±6.20.565/ 0.818
PV area (cm2)7.6±1.38.0±2.30.781
Ratio Aortic annulus min /pulmonary annulus min/max1.0±0.1/ 1.0±0.11.0±0.04/ 0.9±0.10.118/ 0.374
Ratio LVOT/ RVOT1.1±0.21.0±0.20.782


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